The monthly ACT ATOD Research eBulletin is a concise summary of newly-published research findings and other research activities of particular relevance to ATOD and allied workers in the ACT.
Its contents cover research on demand reduction, harm reduction and supply reduction; prevention, treatment and law enforcement. ATODA's Research eBulletin is a resource for keeping up-to-date with the evidence base underpinning our ATOD policy and practice.
: The aim of this study was to explore beliefs about tobacco dependence treatment from the perspective of staff and clients in addiction treatment settings.
: A qualitative study was conducted between August and November 2013 using grounded theory methodology. Participants were recruited from four government-funded drug and alcohol services in a regional centre of New South Wales, Australia. Treatment centre staff (n = 10) were interviewed using a semistructured interview guide and two focus groups (n = 5 and n = 6) were held with clients of the same treatment centres.
: Both clients and staff wish to do more about tobacco use in addiction treatment services, but a number of barriers were identified. Staff barriers included lack of time, tobacco-permissive organisational culture, lack of enforcement of smoke-free policies, beliefs that tobacco is not a treatment priority for clients and that clients need to smoke as a coping strategy, and perceptions that treatment was either ineffective or not used by clients. Clients reported smoking as a habit and for enjoyment or stress relief, seeing staff smoking, nicotine replacement therapy unaffordability and perceptions that nicotine replacement therapy may be addictive, and inability to relate to telephone cessation counselling as barriers to quitting smoking.
: Client and staff perceptions and attitudes about the treatment of tobacco, particularly those relating telephone support and nicotine replacement therapy, provided information, which will inform the design of smoking cessation programs for addiction treatment populations.
Reference: Wilson, AJ, Bonevski, B, Dunlop, A, Shakeshaft, A, Tzelepis, F, Walsberger, S, Farrell, M, Kelly, PJ & Guillaumier, A 2016, ‘“
, vol. 35, no. 1, pp. 92-101.
These same barriers to addressing tobacco dependence in specialist AOD treatment and support settings have also been previously identified in the ACT. The
identified these issues and, in response, piloted a number of initiatives that were later implemented more broadly through the
. This involved providing support to reduce the permissive smoking culture, and as a result of the project many AOD treatment and support services have:
Other projects have further enabled specialist AOD treatment and support services to address barriers to managing tobacco dependence. For example:
How serious are the use of, and barriers in access to, opioid analgesics worldwide?
An international team of researchers, including Professor Richard Mattick from NDARC, prepared a report for the International Narcotics Control Board that aimed ‘to provide up-to-date worldwide, regional, and national data for changes in opioid analgesic use, and to analyse the relation of impediments to use of these medicines’. They found that, over the past decade, use of common opioid analgesics such as codeine, morphine and oxycodone has increased more than fourfold in Australia and twofold worldwide. The paper shows ‘the extent of progress that has occurred during a decade worldwide in terms of a doubling of use [of opioid analgesics], but while use has substantially increased in many regions, change in use in low-income and middle-income regions remains low, and use unbalanced. The number of impediments to availability reported by countries is significantly associated with…use, as are country gross domestic product and country level of development as indexed by the Human Development Index...’
Berterame, S et al
. 2016, ‘Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study
’, The Lancet
, online ahead of print, open access
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How can public health measures be used to reduce the current USA epidemic of drug overdose deaths?
The United States Centers for Disease Control (CDC) reports that ‘Since 2000, the rate of deaths from drug overdoses has increased 137% [in the USA], including a 200% increase in the rate of overdose deaths involving opioids (opioid pain relievers and heroin)…More persons died from drug overdoses in the United States in 2014 than during any previous year on record. From 2000 to 2014 nearly half a million persons in the United States have died from drug overdoses. In 2014, there were approximately one and a half times more drug overdose deaths in the United States than deaths from motor vehicle crashes. Opioids, primarily prescription pain relievers and heroin, are the main drugs associated with overdose deaths. In 2014, opioids were involved in 28,647 deaths, or 61% of all drug overdose deaths; the rate of opioid overdoses has tripled since 2000. The 2014 data demonstrate that the United States’ opioid overdose epidemic includes two distinct but interrelated trends: a 15-year increase in overdose deaths involving prescription opioid pain relievers and a recent surge in illicit opioid overdose deaths, driven largely by heroin’.
‘The increased availability of heroin, combined with its relatively low price (compared with diverted prescription opioids) and high purity appear to be major drivers of the upward trend in heroin use and overdose. The rate of drug overdose deaths involving synthetic opioids nearly doubled between 2013 and 2014. This category includes both prescription synthetic opioids (e.g., fentanyl and tramadol) and non-pharmaceutical fentanyl manufactured in illegal laboratories (illicit fentanyl).’
CDC concludes ‘To reverse the epidemic of opioid drug overdose deaths and prevent opioid-related morbidity, efforts to improve safer prescribing of prescription opioids must be intensified…In addition, efforts are needed to protect persons already dependent on opioids from overdose and other harms. This includes expanding access to and use of naloxone (a safe and effective antidote for all opioid-related overdoses) and increasing access to medication-assisted treatment, in combination with behavioral therapies. Efforts to ensure access to integrated prevention services, including access to syringe service programs when available, is also an important consideration to prevent the spread of hepatitis C virus and human immunodeficiency virus infections from injection drug use.
Public health agencies, medical examiners and coroners, and law enforcement agencies can work collaboratively to improve detection of outbreaks of drug overdose deaths involving illicit opioids (including heroin and illicit fentanyl) through improved investigation and testing as well as reporting and monitoring of specific drugs, and facilitate a rapid and effective response that can address this emerging threat to public health and safety’.
Rudd, RA, Aleshire, N, Zibbell, JE & Gladden, RM 2015, ‘Increases in drug and opioid overdose deaths—United States, 2000–2014’, MMWR; Morbidity and Mortality Weekly Report
, vol. 6, early release, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm64e1218a1.htm?s_cid=mm64e1218a1_e
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How likely is it that the new Primary Health Networks will improve the efficiency, effectiveness and coordination of primary health care delivery?
Public Health Research & Practice
commissioned three viewpoints on the establishment of the 31 new Primary Health Networks (PHNs) for a primary health care themed issue of the journal: from the Australian Government Department of Health (DoH), the Public Health Association of Australia (PHAA) and a Sydney-based PHN. The authors were asked to focus particularly on how the newly established networks might help to integrate public health within the primary health care landscape.
The DoH authors concluded that ‘The potential strengths of PHNs lie in their ability to focus on both the individual and the population, and in having regional scope within a nationally consistent framework. The strategies to improve and integrate public health within the primary care landscape are not unique: many of the hallmarks of successful collaboration with public health will be the same as successful collaboration more broadly’.
The PHAA writers’ conclusion was ‘Nearly $900 million was committed by the former Abbott coalition government for PHNs to deliver primary health care. At the same time, nearly $800 million was cut from the federal Health Flexible Funds over four years. These funds are largely used for prevention and treatment. If the focus becomes too narrow and the positive lessons from Medicare Locals are not transferred to the new organisations, the clinical care merry-go-round will simply keep turning. There has been a great deal of pain for many dedicated health professionals in the constant reinvention of primary health care organisations over the past decade. It is now time to settle into delivering genuine primary health for the whole community’.
The view of the PHN was that ‘PHNs are a major step forward, moving Australia towards a world-class, person-centred healthcare system. If PHNs manage this process well, the potential for improved experience of care, better health outcomes, greater service efficiency and enhanced provider satisfaction in the Australian health system will be substantial.’
Booth, M, Hill, G, Moore, MJ, Dalla, D, Moore, MG & Messenger, A 2016, ‘The new Australian Primary Health Networks: how will they integrate public health and primary care? ‘, Public Health Research & Practice
, vol. 26, no. 1, pp. e2611603, open access http://www.phrp.com.au/issues/january-2016-volume-26-issue-1/the-new-australian-primary-health-networks-how-will-they-integrate-public-health-and-primary-care
Comment: On 6 December 2015 the Australian Government announced $241.5 million over 4 years in additional drug and alcohol treatment funding to be commissioned through Primary Health Networks. This investment is welcomed and needed. According to the New Horizons report, demand for drug treatment in Australia is at least double the available places.
The decision to commission this drug and alcohol treatment through Primary Health Networks was a surprise to the sector. This approach was not recommended in the New Horizons report. Drug and alcohol treatment extends beyond primary care and the medical model.
The sector will need to keep a close eye on developments to ensure this funding injection gets to where it is needed: more people accessing more specialist drug and alcohol interventions in more places.
ATODA, Capital Health Network [ACTPHN] and ACT Health are working in partnership to support the needs assessment, planning, commissioning, implementation and evaluation of this new drug treatment investment in the ACT.
An independent and separate evaluation of the Primary Health Networks role in commissioning drug and alcohol treatment should be undertaken.
Would an increase in the use of e-cigarettes in developing countries have a positive or negative effect on public health?
‘In response to the increasing availability of ENDS [electronic nicotine delivery systems], the World Health Organization (WHO) released a report on October 2014 through the Framework Convention on Tobacco Control encouraging stronger control measures on the manufacture and sale of these products. In particular, the report proposed stronger restrictions on advertisements to avoid attracting youth and never smokers, along with a ban on ENDS use in public spaces.’
article in a recent issue of JAMA
discusses the threats to public health from e-cigarettes in low- and middle-income countries (LMICs). The authors point out that ‘Eighty-four percent of the world’s smokers live in LMICs...[and]The health effects of ENDS can stress LMIC health systems relatively more than health systems in high-income countries…The tobacco industry, possibly in response to declining sales of conventional cigarettes, has turned its attention to e-cigarettes in the past year…Technology-interested youth in LMICs are most likely to adopt e-cigarette smoking behaviors, making them an attractive target for recruitment’. They conclude that ‘Developing nations should not underestimate the availability and targeted marketing of ENDS within their borders and should place e-cigarettes under the purview of their medical and pharmaceutical regulatory boards…
Even though e-cigarettes may have a future as smoking cessation tools, evidence to support this indication is lacking’.
Chang, AY & Barry, M 2015, ‘Viewpoint: The global health implications of e-cigarettes
, vol. 314, no. 7, pp. 663-64.
Comment: ACT Health has commissioned ATODA to do a small e-cigarette information for workers and the community.
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What types of programs are more likely to guard against at-risk youths and offenders from offending in future?
An analysis of the literature on programs aiming to prevent at-risk youths and offenders from future offending found that, ‘From 1988 through early 2002 many of the programs implemented in corrections have been based on the idea that increasing surveillance and control over at-risk youths and offenders and increasing the severity of punishment would reduce future criminal activity.
Research examining these programs using experimental designs demonstrates that interventions based solely on these philosophies have not been effective. Our examination of the research demonstrates that there is little if any evidence that these types of programs reduce recidivism. Prison sentences, correctional boot camps, intensive community supervision and other interventions designed to increase control or make punishment more onerous are not effective in reducing recidivism. In fact, some programs…actually appear to increase later offending. Another disappointing finding is that there is little evidence that providing at-risk youths and offenders with opportunities in the community like jobs and housing is successful in reducing recidivism if these opportunities are not combined with some type of rehabilitation that focuses on thinking, problem solving, or cognitions’.
However they also found that ‘some interventions are effective in reducing future recidivism. Effective interventions are developed from the perspective of therapeutic rehabilitation. These programs address the specific problems that are associated with offenders’ criminal activities. Cognitive skills training, drug treatment, whether associated with a drug court or provided in prison or in the community, and education are examples of some of the interventions that have an impact on recidivism. Less clear is the impact of programs for batterers and sex offenders’.
MacKenzie, DL & Farrington, DP 2015, ‘Preventing future offending of delinquents and offenders: what have we learned from experiments and meta-analyses?
’, Journal of Experimental Criminology
, vol. 11, no. 4, pp. 565-95.
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What has been learned from the Jerry Lee Program of 12 randomized trials of restorative justice?
: They conducted and measured outcomes from the Jerry Lee Program of 12 randomized trials over two decades in Australia and the United Kingdom (UK), testing an identical method of restorative justice taught by the same trainers to hundreds of police officers and others who delivered it to 2231 offenders and 1179 victims in 1995–2004. The article provides a review of the scientific progress and policy effects of the program, as described in 75 publications and papers arising from it, including previously unpublished results of our ongoing analyses.
: After random assignment in four Australian tests diverting criminal or juvenile cases from prosecution to restorative justice conferences (RJCs), and eight UK tests of supplementing criminal or juvenile proceedings with RJCs, we followed intention-to-treat group differences between offenders for up to 18 years, and for victims up to 10 years.
: They distil and modify prior research reports into 18 updated evidence-based conclusions about the effects of RJCs on both victims and offenders. Initial reductions in repeat offending among offenders assigned to RJCs (compared to controls) were found in 10 of our 12 tests. Nine of the ten successes were for crimes with personal victims who participated in the RJCs, with clear benefits in both short- and long-term measures, including less prevalence of post-traumatic stress symptoms. Moderator effects across and within experiments showed that RJCs work best for the most frequent and serious offenders for repeat offending outcomes, with other clear moderator effects for poly-drug use and offense seriousness.
: RJ conferences organized and led (most often) by specially-trained police produced substantial short-term, and some long-term, benefits for both crime victims and their offenders, across a range of offense types and stages of the criminal justice processes on two continents, but with important moderator effects. These conclusions are made possible by testing a new kind of justice on a programmatic basis that would allow prospective meta-analysis, rather than doing one experiment at a time. This finding provides evidence that funding agencies could get far more evidence for the same cost from programs of identical, but multiple, RCTs of the identical innovative methods, rather than funding one RCT at a time.
Sherman, LW, Strang, H, Barnes, G, Woods, DJ, Bennett, S, Inkpen, N, Newbury-Birch, D, Rossner, M, Angel, C & Mearns, M 2015, ‘Twelve experiments in restorative justice: the Jerry Lee program of randomized trials of restorative justice conferences’, Journal of Experimental Criminology
, vol. 11, no. 4, pp. 501-40, open access http://link.springer.com/article/10.1007/s11292-015-9247-6?wt_mc=alerts.TOCjournals
Comment: Four of the experiments that are reviewed here were conducted in Canberra as part of the RISE Project. RISE is an acronym for Reintegrative Shaming Experiments. Three of the authors of this important study are, or were, Canberra based: Nova Inkpen, Malcolm Mearns and Heather Strang.
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To what extent is there a causal relationship between cannabis use and psychosis?
A new literature review of the relationship between cannabis use and psychosis found that ‘cannabis does not in itself cause a psychosis disorder. Rather, the evidence leads us to conclude that both early use and heavy use of cannabis are more likely in individuals with a vulnerability to psychosis. The role of early and heavy cannabis use as a prodromal sign merits further examination, along with a variety of other problem behaviors (e.g., early or heavy use of cigarettes or alcohol and poor school performance). Future research studies that focus exclusively on the cannabis-psychosis association will therefore be of little value in our quest to better understand psychosis and how and why it occurs’.
Ksir, C & Hart, CL 2016, ‘Cannabis and psychosis: a critical overview of the relationship
’, Current Psychiatry Reports
, vol. 18, no. 2, p. 12.
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To what extent is the .05g% drink driving cut-off approach a sound model for drug driving interventions?
As the marijuana legalization movement advances [in the USA], states face a jurisprudential dilemma in addressing the burgeoning public health issue of “drugged driving.” Zero-tolerance laws targeting drivers with any illegal drugs in their systems, currently justified under a “jurisprudence of prohibition” based on the blameworthiness of the drug itself, are no longer a good fit due to legalization. Instead, states have attempted to treat marijuana like alcohol by importing drunk driving’s “jurisprudence of dangerousness” through enactment of per se driving under the influence of (DUI) marijuana laws redefining DUI as driving with a certain quantifiable amount of THC, marijuana’s main psychoactive compound, in one’s blood. These laws are legitimate, legislators claim, because they are analogous to per se .08 percent blood-alcohol concentration (BAC) impairment laws. What lawmakers have forgotten, and what legal scholars have largely neglected, is the buried and colorful history of drunk driving’s jurisprudence of dangerousness and the scientific framework for proving the link between specific BACs and crash risk established by the [USA’s] first “traffic czar,” William Haddon Jr. Under this framework—which focuses first and foremost on fatal single-car crashes and case-control studies with a randomly selected control group—the illegitimacy of the new wave of DUI marijuana laws is painfully obvious. In fact, the few single-car crash and case-control studies that have been conducted have found no relationship between THC blood levels and an increased relative crash risk. Properly understood, the history of drunk driving jurisprudence offers what is still the only valid scientific framework for criminalizing chemical impairment.
Roth, A 2015, ‘The uneasy case for marijuana as chemical impairment under a science-based jurisprudence of dangerousness’, Cal. L. Rev
., vol. 103, no. 4, pp. 841-917, open access http://scholarship.law.berkeley.edu/californialawreview/vol103/iss4/2
Comment: This article, available in free full text online, is a must read for anyone interested in the theory and practice underpinning drink-driving and drug drive interventions. It presents a forceful argument that the approach used in the ACT of criminalising driving with any detectable level of three illegal drugs in the body is not based on sound epidemiological evidence, in direct contrast to the approach we take with drink-driving.
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Are campaigns such as Dry July in Australia and Dry January in the UK beneficial, or could they do more harm than good?
An article in the British Medical Journal
contrasts the views of Ian Hamilton, York University, and Ian Gilmore, Liverpool University.
Hamilton writes ‘Now in its fourth year, the Dry January campaign, which uses peer pressure to encourage abstinence from alcohol for the month, is promoted by the charity Alcohol Concern in England and Wales…Alcohol Concern’s ambition is to alter people’s relationship with alcohol by encouraging us to reduce the amount we drink, not just for a month but for life. Unfortunately, this type of campaign has had no rigorous evaluation’.
‘It is not clear who Dry January is targeting. Because participants select themselves it could attract the people at lowest risk from health problems related to alcohol. Because they consume less alcohol they are also likely to find a month of abstinence relatively easy, as a recent study indicates. The campaign should offer a range of advice and more carefully tailor these messages to match the individual’s use of alcohol. For example, one high risk group is people aged over 65. Trying to communicate a message about alcohol to the over 65s at the same time as the under 25s risks the message not being heard, as the way these groups use alcohol is likely to be different.’
‘Many of us can be economical with the truth when it comes to how much we drink. Research comparing self reported alcohol consumption with total alcohol sold found a large disparity. It is not clear whether this mass denial affects Dry January. At the very least an appraisal of how much and how often an individual really drinks will influence whether they see a need to test their ability to go without alcohol for a month or simply view the campaign as more nagging and switch off. If people aren’t honest with themselves about their drinking, how can Dry January help?.’
Gilmore’s view is different: ‘Our per capita consumption has doubled over 40 years, we have 1.5 million heavily dependent drinkers in this country, and alcohol has become a central part of most social occasions. So what could possibly be wrong with encouraging and supporting the estimated two million or so adults who decide on Dry January—to take a month off the booze and have time to reflect on their drinking?...There has been some support in kind from Public Health England, and its independent evaluation of 2015’s Dry January showed that 67% of participants said they had had a sustained drop in their drinking six months on. In an earlier evaluation by the University of Sussex, 79% of participants said they saved money, 62% of participants said they slept better and had more energy, and 49% said they lost weight…Release of the UK chief medical officers’ guidelines on drinking is timely, with their emphasis on having several alcohol-free days each week…Although it is unlikely that this will have much impact on health measures such as blood pressure and insulin resistance, it should be a focus for further research. Until we know of something better, let’s support growing grassroots movements like Dry January and Dry July in Australia and take a month off.’
Hamilton, I & Gilmore, I 2016, ‘Could campaigns like Dry January do more harm than good
?’, BMJ: British Medical Journal
, vol. 352, p. i143.
Comment: This exchange is interesting as it raises questions about evidence-based interventions: while we wish to support community-based approaches with wide reach, many of them operate without a sound program theory, i.e. with little or no underpinning research into the likelihood that they will attain their objectives and not produce adverse unintended consequences.
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Which is more successful in reducing problematic alcohol use, inpatient or outpatient treatment programs?
A review of the evidence on whether inpatient treatment or outpatient programs for alcohol abuse is more effective found that ‘…the complexity of these disorders and their care makes the development of a single universal treatment unlikely. The findings from the current review also do not suggest that there is a single approach that is consistently effective for all individuals. In terms of the relative benefits of inpatient/residential approaches compared to a purely outpatient approach, again the findings are mixed. This is likely to support a greater move to outpatient programs, ideally of longer duration, as a primary treatment for most jurisdictions for economic reasons’.
The researchers commented, however, that ‘specific characteristics of the individual seeking treatment may make one treatment approach more effective than another. Furthermore, both inpatient and outpatient programs can have barriers to entry for specific individuals that include limited accessibility and availability of these programs. They can also vary widely depending upon multiple factors (such as geographic location and health care coverage), and…the specific details within each program also varies widely. There is some evidence to suggest that individuals with social and environmental instability and concomitant psychiatric conditions may benefit more from the structure and goal intensity of inpatient programs, and might potentially have a higher likelihood of successful recovery. In contrast, there is some evidence to suggest that individuals with a high degree of motivation and social support may do better in an outpatient setting…Future research must take into account both patient and treatment factors in order to accurately identify which aspects of treatment are necessary and sufficient for a given patient profile. An ideal system would provide access to both types of care, inpatient and outpatient, depending upon needs. However, it is likely that the long-term move to increased outpatient care is likely to continue for economic reasons, and the evidence from the published literature shows, that for most individuals, a long-term outpatient program is likely better than a shorter-term inpatient/residential program. At this point, the inconclusive evidence suggests that the details included in the individual program do not appear as important as the time spent in such a program. The only conclusion that can be made is that the longer an individual is in a program, then the more likely it is that a positive outcome is to occur’.
Hamza, DM & Silverstone, PH 2015, ‘In the treatment of alcohol abuse there are no clear differences in outcomes between inpatient treatment and outpatient programs’, Journal of Addiction & Prevention
, vol. 3, no. 1, open access http://www.avensonline.org/fulltextarticles/jap-2330-2178-03-00017.html
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How effective is short-term restriction of alcohol sales on the risk of alcohol-related injury?
Across Western Australia (and elsewhere), under state licensing laws there are state-wide alcohol sales restrictions imposed on Good Friday and Christmas Day each year. Researchers based at the National Drug Research Institute conducted a population-based cohort study using emergency department injury presentation data for the period 1st January 2002 to 1st January 2015. Risk of injury during the alcohol-related time of day affected by the alcohol restrictions (intervention periods, including Good Friday and Christmas Day) were compared to the same time of day over a number of control days. The researchers found that ‘The crude injury risk was considerably lower during the alcohol restriction periods compared to control periods in both metropolitan and non-metropolitan areas. The protective effect observed on the days of the alcohol restrictions remained significant, and largely unchanged, when potential confounding effects were controlled for.’ They concluded that ‘The significant reduction in alcohol-related injury presentations observed for public holiday periods with alcohol restrictions were likely caused by the alcohol restriction policy and its direct effect on alcohol supply’.
Liang, W, Gilmore, W & Chikritzhs, T 2016, ‘The effect of short-term alcohol restriction on risk of alcohol-related injury: a state wide population-based study
’, International Journal of Drug Policy
, vol. 28, pp. 55-59.
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What research is available on interventions to improve outcomes for people with fetal alcohol spectrum disorders during adolescence and adulthood?
A systematic review of the literature on interventions on individuals with fetal alcohol spectrum disorders (FASDs) examined 32 studies of which the vast majority targeted early to middle childhood. The researchers found that ‘Two studies focused on early intervention in the postnatal period, and 6 studies aimed to improve attention and/or self-regulation in childhood. Three of these provided promising evidence on improving self-regulatory difficulties for children with FASDs. Nine studies focused on improving specific areas of dysfunction. Six studies addressed social skills; 3 of these used an adaptation of a well-validated social skills program. Three studies provided promising initial evidence that parents and caregivers could benefit from support with child behavior and a further 4 studies provided education and advocacy for parents/caregivers, teachers, or child welfare workers. The final 2 studies were aimed at supporting parents who were themselves affected by prenatal alcohol exposure’. They concluded that ‘There is growing evidence for interventions that improve outcomes for early to middle childhood. However, a lack of research exists outside of this developmental period. This lack of research is concerning given the potential positive impact of early intervention, for individuals and, financially, for governments. In addition, the lack of interventions for adolescents and adults further highlights the widening developmental gap and the potential influence of secondary disabilities for this at-risk population’.
Reid, N, Dawe, S, Shelton, D, Harnett, P, Warner, J, Armstrong, E, LeGros, K & O’Callaghan, F 2015, ‘Systematic review of fetal alcohol spectrum disorder interventions across the life span
’, Alcoholism: Clinical and Experimental Research
, vol. 39, no. 12, pp. 2283-95.
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How effective are brief interventions in emergency departments on alcohol consumption?
‘Despite ambiguous evidence for the effectiveness of alcohol screening with brief interventions (BI) in emergency departments (ED), ambition for their widespread implementation continues to grow’. A systematic review and meta-analysis on studies tested the impact of BIs on alcohol consumption, considering 33 publications covering over 14,000 patients. The researchers found that, ‘Overall, our study is in line with the observation that BI delivered in ED settings might be less effective than BI in PHC [primary health care]. This could be due to various factors: the fast-paced and transient nature of ED settings may inhibit the formation of an efﬁcient and trustworthy working cooperation between patient and clinician, not least as ED attendance is a critical situation in which stress, as well as alcohol intoxication, may limit a patient’s receptiveness and motivation. Moreover, there is generally greater acceptance for the provision of preventive life-style interventions (e.g. for diets and smoking) in PHC settings than in ED’. Their conclusion was that ‘…decision-makers in ED settings should weigh costs and beneﬁts related to BI implementation carefully, and might consider prioritizing the implementation of non-face-to-face BI, or very short forms of BI delivery (e.g. screening with feedback only) in routine practice’.
Schmidt, CS, Schulte, B, Seo, HN, Kuhn, S, O`Donnell, A, Kriston, L, Verthein, U & Reimer, J 2015, ‘Meta-analysis on the effectiveness of alcohol screening with brief interventions for patients in emergency care settings
, doi:10.1111/add.13263 online ahead of print.
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What can liquor industry funded anthropological research contribute to our understanding of anti-social behaviour in night-time economies?
A report (not a refereed journal article) was published last year on this topic. It was authored by a British anthropologist, Dr Anne Fox, and commissioned by Lion Pty Ltd, one of the largest alcohol producers and distributors in Australia. The aim of the study was ‘…to gain a deeper understanding of the drivers of anti-social behaviour in the night-time economy [in Australia and NZ], the role of alcohol in it, and the policy approaches that will best work to address it’. Fox concluded, among other things, that ‘In a nutshell, the central point of this whitepaper is: it is the wider culture that determines the drinking behaviour, not the drinking. You can’t change a culture by simply changing drinking. It is, of course, justifiable to explore the effectiveness of small measures such as advertising restrictions, increases or decreases in price, relaxation or restriction of hours, but such things tinker at the margins of culture and it is doubtful that they will alter the culture of violence and anti-social behaviour in any meaningful way. That must be faced head on with a strong collective will for genuine, lasting whole of community cultural change.’
The report has drawn fire from leading alcohol policy researchers and advocates. Researchers Nicki Jackson and Kypros Kypri, writing in the leading journal Addiction
, state that this is an example of the liquor industry mimicking the for-too-long successful strategies of the tobacco industry, seeking to draw focus away from the interventions that we know work (those most proximate to alcohol-fuelled violence such as not serving intoxicate people) to those interventions for which we have the weakest evidence of effectiveness (such as education and cultural change).
Fox, A 2015, Understanding behaviour in the Australian and New Zealand night-time economies: an anthropological study
, Lion Pty Ltd, n.p., http://www.lionco.com/content/u12/Dr%20Anne%20Fox%20report.pdf
Jackson, N & Kypri, K 2015, ‘A critique of Fox’s industry-funded report into the drivers of anti-social behaviour in the night-time economies of Australia and New Zealand
, online ahead of print.
And see DrinkTank/FARE: ‘Researchers appalled at alcohol report’ http://drinktank.org.au/2016/01/researchers-appalled-at-alcohol-report/
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ACT Government, Justice and Community Safety Directorate 2016, Expanding the use of Criminal Infringement Notices in the Australian Capital Territory: options paper—released for consultation with the community by the Justice and Community Safety Directorate, January 2016, Justice and Community Safety Directorate, Canberra, http://www.justice.act.gov.au/news/view/1695/title/expanding-the-use-of-criminal .
Australia, Parliamentary Budget Office 2015, Costing: legalising marijuana, Parliamentary Budget Office, Canberra, http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Budget_Office/Publicly_released_PBO_responses_-_excluding_caretaker_costings .
Caulkins, JP, Kilmer, B, Kleiman, MAR, MacCoun, RJ, Midgette, G, Oglesby, P, Pacula, RL & Reuter, PH 2015, Options and issues regarding marijuana legalization, Santa Monica, CA, http://www.rand.org/pubs/perspectives/PE149.html .
Communicable Diseases Network Australia 2015, National Blood-borne Viruses and Sexually Transmissible Infections Surveillance and Monitoring Plan 2014-2017. Prepared through the Communicable Diseases Network Australia (CDNA). Endorsed by the Australian Health Protection Principal Committee (AHPPC) June 2015, Commonwealth Department of Health, Canberra.
European Monitoring Centre for Drugs and Drug Addiction 2015, Minimum quality standards for drug demand reduction interventions in the EU, Publications Office of the European Union, Luxembourg, http://www.emcdda.europa.eu/news/2015/eu-minimum-quality-standards .
---- 2015, Prevention of addictive behaviours, Publications Office of the European Union, Luxembourg, http://www.emcdda.europa.eu/publications/insights/preventing-addictive-behaviours
Foundation for Alcohol Research and Education 2016, Risky business: the alcohol industry’s dependence on Australia’s heaviest drinkers, Foundation for Alcohol Research and Education, Canberra, http://www.fare.org.au/2016/01/risky-business-the-alcohol-industrys-dependence-on-australias-heaviest-drinkers .
Lloyd, B & Killian, J 2015, Alcohol and drug testing in wastewater: summary results from March 2015 testing in Melbourne, Turning Point, Fitzroy, Victoria, http://www.turningpoint.org.au/Media-Centre/Latest_News/Alcohol-and-Drug-Testing-in-Wastewater-research.aspx .
Mason, P, Fullwood, Y, Singh, K & Battye, F 2015, Payment by results: learning from the literature, ICF Consulting Services, Birmingham, UK, https://www.nao.org.uk/wp-content/uploads/2015/06/Payment-by-Results-Learning-from-the-Literature.pdf .
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