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.
This report presents the findings of the Specialist Homelessness Services Collection for 2012-13, and describes the clients who received specialist homelessness support, the assistance they sought and were provided, and the outcomes achieved for those clients.
: Australian Institute of Health and Welfare 2013. Specialist homelessness services:2012–2013. Cat. no. HOU 27. Canberra: AIHW
This issue discusses the issues experienced by children and young people who have a parent in prison, and implications for supporting this target group. It is based upon the findings of a qualitative research project, commissioned by SHINE for Kids and implemented by ICPS in 2012-13, which interviewed 12 children and young people between the ages of 6 and 18 with a parent incarcerated in the ACT, along with 12 parents and caregivers.
The Quarterly Research Update aims to keep stakeholders informed about the projects we are undertaking. The December 2013 update provides information on the following current research projects:
(National Statement) is Australia’s primary ethical guidance document for those involved in research with human participants. The National Health and Medical Research Council is currently undertaking a survey of users of the National Statement. This survey will determine whether the National Statement is effectively serving the needs of the Australian research community and will inform any further revisions.
. To participate, please
One of the key sources of information on alcohol and other drug treatment services is the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS). Publicly funded alcohol and other drug treatment services provide information on treatment episodes for the AODTS NMDS and the
auspices this data collection. The collection began in 2000 and these data have been used to inform state, territory and Australian government policies, a broad range of research activities and treatment service provision.
State, territory and Australian government stakeholders have approved enhancements to the collection, so from 2014 it will:
Some analyses described either require, or would be improved by, future data development activities for this collection.
. If you would like to provide feedback, email AIHW at firstname.lastname@example.org
: Australian Institute of Health and Welfare 2013. Developing client-based analyses for reporting on alcohol and other drug treatment services. Drug Treatment Series no. 22. Cat. no. HSE 143 . Canberra: AIHW.
Most of the reports and research items referenced below are available from the Alcohol and Other Drug Council of Australia’s
What can be done to increase hepatitis C treatment among people who inject drugs?
Brief summaries of other research findings are available from the NDSIS national ATOD workforce development portal Drugfields: Research in Brief
A study of people who inject drugs (PWID) who attended Australia Needle and Syringe Programs over the period 1999 and 2011 found that the proportion currently receiving treatment for hepatitis C virus (HCV) increased from 1.1 per cent to 2.1 per cent, and the proportion who had received treatment at some time increased from 3.4 per cent to 8.6 per cent. Men were more likely than women to have received treatment. The researchers state that ‘Strategies are required to increase the proportion of PWID assessed and treated for HCV infection to address the increasing burden of disease. Specific approaches that target women may also be warranted. Continued surveillance of HCV treatment uptake among PWID will be important to monitor the roll-out of simple, safe and more effective HCV treatments expected to be available in the future’.
Iversen, J, Grebely, J, Topp, L, Wand, H, Dore, G & Maher, L 2013, ‘Uptake of hepatitis C treatment among people who inject drugs attending Needle and Syringe Programs in Australia, 1999–2011’, Journal of Viral Hepatitis
, online ahead of print.
Comment: New HCV treatment options are now starting to come online which are far shorter than those used in the past, have far fewer side effects and are often more effective. The availability of these products will not have significant population health impacts unless a much higher proportion of people who inject drugs are supported in accessing this treatment.
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Do people who inject drugs understand that there is a higher risk of contracting hepatitis C from sharing needles than from unprotected sex?
‘Evidence indicates minimal hepatitis C (HCV) sexual transmission risk among HIV negative heterosexual partners.’ Researchers in the United Kingdom conducted a qualitative life history study with people who had been injecting drugs for over six years, to explore the social practices and conditions of long-term HCV avoidance. They found that ‘The majority of participants in relationships reported “discriminate” needle and syringe sharing with their primary sexual partner. Significantly, and in tension with biomedical evidence, participants commonly rationalised syringe sharing with sexual partners in terms of “risk equivalence” with sexual practices in regard to HCV transmission. Participants’ uncertain knowledge regarding HCV transmission, coupled with unprotected sexual practices perceived as being normative were found to foster “risk equivalence” beliefs and associated HCV transmission potential’. The researchers concluded that ‘HCV prevention messages that “add on” safe sex information can do more harm than good, perpetuating risk equivalence beliefs and an associated dismissal of safe injecting recommendations among those already practicing unprotected sex.
Harris, M & Rhodes, T 2013, ‘Injecting practices in sexual partnerships: hepatitis C transmission potentials in a “risk equivalence” framework’, Drug and Alcohol Dependence
, vol. 132, no. 3, pp. 617-23.
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Are young adults in Australia more likely to binge drink if they buy alcohol from bottle shops than if they drink in licensed premises?
An online survey of over two thousand Australians aged 18–30 years who had consumed alcohol in the past year found that ‘Of participants who drank the previous Saturday night…, 46% bought alcohol only from off-licence outlets (e.g. bottle shops), 19% bought from both off-licence and on-licence outlets (e.g. clubs, bars), and 23% bought only from on-licence outlets. Participants who bought alcohol from off-licence outlets were equally likely to binge-drink as participants who bought only from on-licence outlets…,
but they drank more cheaply and usually drank at home. Participants who bought alcohol from both off-licence and on-licence outlets were more likely to binge-drink…,
drank both at home and in public places, were at higher risk of an alcohol use disorder and were more likely to have used stimulants the previous Saturday night’.
The researchers concluded that ‘these findings suggest that off-licence outlets are the primary source of alcohol for young adults who binge-drink in Australia. Strategies that aim to reduce binge drinking need to target the purchasing of alcohol from off-licence outlets. They also need to recognise that the bulk of binge-drinking among young adults occurs in private homes, and while this pattern of drinking may be less visible, it nonetheless contributes to alcohol-related morbidity. Policies that fail to recognise the role of off-licence outlets in drinking among young adults overlook a major contributor to alcohol related harm in Australia’.
McKetin, R, Livingston, M, Chalmers, J & Bright, D 2013, ‘The role of off-licence outlets in binge drinking: a survey of drinking practices last Saturday night among young adults in Australia’, Drug and Alcohol Review
, online ahead of print.
Comment: In the ACT and other Australian jurisdictions, much work is in hand to identify the optimal approach to liquor licensing as an alcohol harm reduction intervention. To date there has been insufficient attention paid to the roles of packaged liquor in creating alcohol-related harm. Studies such as this highlight the need to better regulate packaged liquor sales at the same time as better regulating drinking at licensed premises.
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If young people consume both energy drinks and alcohol on the same day are they likely to drink more than if they consume alcohol without energy drinks?
Surveys of college students in the United States found that ‘On days when students consumed energy drinks and alcohol, compared with days when they drank alcohol but no energy drinks, they drank more alcoholic drinks, reached a higher [estimated blood alcohol content], and showed a trend toward spending more time drinking…the increased alcohol consumption on days with energy drink use may also support the process of alcohol priming, such that energy drink consumption may increase motivations to drink more alcohol’. The researchers drew the conclusions that ‘When late adolescents consume energy drinks and alcohol, they are more likely to consume more alcohol, become more intoxicated, and experience more negative consequences compared with when they consume only alcohol. Prevention programs designed to reduce the risks associated with the consumption of energy drinks and alcohol are needed’.
Patrick, ME & Maggs, JL 2013, ‘Energy drinks and alcohol: links to alcohol behaviors and consequences across 56 days’, The Journal of adolescent health: official publication of the Society for Adolescent Medicine
, online ahead of print.
Comment: The manufacturers and distributors of energy drinks are currently running an international campaign to convince policy-makers and the public that energy drinks are benign products and that their consumption is unrelated to alcohol consumption and alcohol-related harms. This study adds to the evidence base refuting that industry position.
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Did the increase in the alcopops tax have any impact on alcohol-related harms among young people on the Gold Coast?
A study over the period 2005 to 2010 of young people aged fifteen to twenty-nine who presented to the emergency departments of Gold Coast hospitals found that ‘Over a third of 15-29-year-olds presented to ED with alcohol-related conditions, as opposed to around a quarter for all other age groups. There was no significant decrease in alcohol-related ED presentations of 15-29-year-olds compared with any of the control groups after the increase in the tax. We found similar results for males and females, narrow and broad definitions of alcohol-related harms, under-19s, and visitors to and residents of the Gold Coast’.
The researchers concluded ‘A more comprehensive approach to reducing alcohol harms in young people is needed…more comprehensive approaches may be required, combining fiscal measures such as volumetric taxation for all alcoholic beverages, along with other supply and demand initiatives…These could include incentives to encourage mid-strength and low-strength beer, restrictions on the availability of drinks with a high alcohol content, more effective regulation of advertising, and increasing the age at which it is legal to drink alcohol…Our study also suggests that other efforts to reduce binge drinking on the Gold Coast, such as increased policing or holding officially sanctioned drug-free and alcohol-free events have not been associated with reductions in ED presentations either. This again suggests the need for a more comprehensive approach to binge drinking among young people’.
Kisely, SR, Pais, J, White, A, Connor, J, Quek, L-H, Crilly, JL & Lawrence, D 2011, ‘Effect of the increase in “alcopops” tax on alcohol-related harms in young people: a controlled interrupted time series’, Medical Journal of Australia
, vol. 195, no. 11-12, pp. 690-3.
Comment: Although this study was published two years ago, it is included in this issue of the ATODA Research eBulletin as this is the time of the year when many young people (including schoolies on the Gold Coast) experience diverse alcohol-related harms. It emphasises the need for a comprehensive range of interventions, and the disappointing outcomes of the application of the alcopops tax
What would be the effects on health and government revenues of changing alcohol taxation in Australia?
: To examine health and economic implications of modifying taxation of alcohol in Australia.
Design and setting
: Economic and epidemiological modelling of four scenarios for changing the current taxation of alcohol products, including: replacing the wine equalisation tax (WET) with a volumetric tax; applying an equal tax rate to all beverages equivalent to a 10% increase in the current excise applicable to spirits and ready-to-drink products; applying an excise tax rate that increases exponentially by 3% for every 1% increase in alcohol content above 3.2%; and applying a two-tiered volumetric tax. We used annual sales data and taxation rates for 2010 as the base case.
Main outcome measures
: Alcohol consumption, taxation revenue, disability-adjusted life-years (DALYs) averted and health care costs averted.
: In 2010, the Australian Government collected close to $8.6 billion from alcohol taxation. All four of the proposed variations to current rates of alcohol excise were shown to save money and more effectively reduce alcohol-related harm compared with the 2010 base case. Abolishing the WET and replacing it with a volumetric tax on wine would increase taxation revenue by $1.3 billion per year, reduce alcohol consumption by 1.3%, save $820 million in health care costs and avert 59 000 DALYs. The alternative scenarios would lead to even higher taxation receipts and greater reductions in alcohol use and harm.
: Our research findings suggest that any of the proposed variations to current rates of alcohol excise would be a cost-effective health care intervention; they thus reinforce the evidence that taxation is a cost-effective strategy. Of all the scenarios, perhaps the most politically feasible policy option at this point in time is to abolish the WET and replace it with a volumetric tax on wine. This analysis supports the recommendation of the National Preventative Health Taskforce and the Henry Review towards taxing alcohol according to alcohol content.
Doran, CM, Byrnes, JM, Cobiac, LJ, Vandenberg, B & Vos, T 2013, ‘Estimated impacts of alternative Australian alcohol taxation structures on consumption, public health and government revenues’, Medical Journal of Australia
, vol. 199, no. 9, pp. 619-22.
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Does training in self-estimation of blood concentration help people to avoid drink-driving?
An article in a recent issue of Addictive Behaviours
examines studies on the history and effectiveness of blood alcohol concentration (BAC) estimation training in the United States. Drinkers are trained to discriminate distinct BAC levels and thus avoid excessive alcohol consumption. The author explains that ‘BAC estimation training typically combines education concerning alcohol metabolism with attention to subjective internal cues associated with specific concentrations. Estimation training was originally conceived as a component of controlled drinking programs. However, dependent drinkers were unsuccessful in BAC estimation, likely due to extreme tolerance. In contrast, moderate drinkers successfully acquired this ability. A subsequent line of research translated laboratory estimation studies to naturalistic settings by studying large samples of drinkers in their preferred drinking environments. Thus far, naturalistic studies have provided mixed results regarding the most effective form of BAC feedback. BAC estimation training is important because it imparts an ability to perceive individualized impairment that may be present below the legal limit for driving. Consequently, the training can be a useful component for moderate drinkers in drunk driving prevention programs’.
Aston, ER & Liguori, A 2013, ‘Self-estimation of blood alcohol concentration: a review’, Addictive Behaviors
, vol. 38, no. 4, pp. 1944-51.
Comment: Training in the self-estimation of blood alcohol concentrations has never been a prominent feature of harm reduction interventions in Australia. Nonetheless, the findings of this review are of interest, particularly to people providing, or contemplating providing, drink-driver intervention programs.
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Are drivers affected by alcohol more likely to be involved in a fatal accident if they are also using a mobile device at the same time?
Researchers based in Nebraska, USA, analysed trends in road fatalities in the United States caused by alcohol-involved and distracted drivers. They state that ‘Although alcohol-involved traffic fatalities have decreased in recent years, distracted driving fatalities represent an increasing share of total fatalities...Many attribute increases in distracted driving fatalities to the growing use of mobile devices. In fact, volume of text messages is predictive of driving fatalities’. They found that ‘Alcohol-involved drivers who are simultaneously distracted were responsible for 1750 deaths in 2009, an increase of more than 63% from 2005 when there were 1072 deaths. Alcohol use while driving is increasingly responsible for a growing number of fatalities from distracted driving, accounting for 32% of deaths from distracted driving in 2009 versus 24% in 2005. The fatality rate from these crashes increased from 35.9 to 59.2 deaths per 100 billion vehicle-miles traveled after 2005. Alcohol use is quickly increasing as an important factor behind distracted driving fatalities. This has implications for policies combating distracted driving that do not address the role of alcohol use in distracted driving’.
Wilson, FA, Stimpson, JP & Tibbits, MK 2013, ‘The role of alcohol use on recent trends in distracted driving’, Accident Analysis and Prevention
, vol. 60, pp. 189-92.
Comment: A consistent problem with seeking to draw policy lessons from administrative data sets is that people confuse correlation with causality. This study draws attention to the complex interactions between the multiple causes of motor vehicle crashes, showing that driving after consuming alcohol can exacerbate the consequences of other adverse influences on driving, particularly distraction.
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How important a factor is alcohol in 'king hit' deaths?
Researchers based at Monash University, Melbourne, used the National Coronial Information System to retrieve all cases involving a ‘king hit’ within Australia between 2000 and 2012. Of the ninety cases identified, only four were female. Twenty-eight occurred in NSW, and 24 in both Queensland and Victoria, mostly at a hotel or pub, or a public space such as a street or park. Toxicology reports were available in 68 cases. ‘Of these, 53 cases involved the use of alcohol or other drugs (other than those used in hospital treatment). Forty-nine cases (73%) involved the use of alcohol, with a median alcohol concentration of 0.144g/100mL [0.14g%] and 0.191g/100mL [0.19g%] in ante-mortem and post-mortem specimens, respectively. Illicit drugs were detected in 10 cases of which most involved cannabis. Other pharmaceutical drugs were detected in 3 cases.’
The researchers explain that ‘Compounding an acknowledged increase in violence and aggression that accompanies alcohol use is the increased risk of serious injury and death to a victim of assault who is under the influence of alcohol’. They conclude ‘Assaults are an ongoing problem in Australia and king hits form a large group of these substance-related and often unprovoked attacks. Importantly, this study indicated that alcohol intoxication increases the risk of victimization, not just aggressive offending… The results of this study reiterate the often fatal consequences of alcohol-fueled violence in Australia’.
Pilgrim, JL, Gerostamoulos, D & Drummer, OH 2013, ‘“King hit” fatalities in Australia, 2000-2012: the role of alcohol and other drugs’, Drug and Alcohol Dependence
, online ahead of print.
Comment: This study is timely considering that a number of governments have rushed to legislate about alcohol-related violence on the basis of isolated cases of ‘king hit’ deaths. It highlights the role of alcohol in these tragedies and shows that alcohol intoxication by both the victim and offender are risk factors in the majority of the deaths.
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Is there any evidence that young Australians thansit from recreational or non-medical use of pharmaceutical opioids to intravenous heroin?
Introduction and Aims
: The non-medical use of pharmaceutical opioids is associated with a range of negative health consequences, including the development of dependence, emergency room presentations and overdose deaths.
Design and Methods
: Drawing on life history data from a broader qualitative study of the non-medical use of painkillers, this brief report presents two cases of transitions from recreational or non-medical pharmaceutical opioid use to intravenous heroin use by young adults in Australia.
: Although our study was not designed to assess whether recreational oxycodone use is causally linked to transitions to intravenous use, polyopioid use places individuals at high risk for progression to heroin and injecting. Our first case, Jake, used a range of analgesics before he transitioned to intravenous use, and the first drug he injected was methadone. Our second case, Emma, engaged in a broad spectrum of polydrug use, involving a range of opioid preparations, as well as benzodiazepines, cannabis and alcohol. Both cases transitioned from oral to intravenous pharmaceutical opioids use and subsequent intravenous heroin use.
Discussion and Conclusions
: These cases represent the first documented reports of transitions from the non-medical or recreational use of oxycodone to intravenous heroin use in Australia. As such, they represent an important starting point for the examination of pharmaceutical opioids as a pathway to injecting drug use among young Australians and highlight the need for further research designed to identify pharmaceutical opioids users at risk of transitions to injecting and to develop interventions designed to prevent or delay these transitions.
Dertadian, GC & Maher, L 2013, ‘From oxycodone to heroin: two cases of transitioning opioid use in young Australians’, Drug and Alcohol Review
, online ahead of print.
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Is unintentional exposure to buprenorphine a health risk for young children?
A study in the United States reviewed over two thousand cases over the period October 2009 to March 2012 where children aged from 28 days to less than six years were unintentionally exposed to buprenorphine. ‘The most commonly identified root causes were medication stored in sight, accessed from a bag or purse, and not stored in the original packaging.’ The conclusions of the study were that ‘Unintentional exposure to buprenorphine can cause central nervous system depression, respiratory depression, and death in young children. [Four of the children died as a result of exposure to buprenorphine.] Exposure rates to film formulations are significantly less than to tablet formulations. Package and storage deficiencies contribute to unintentional exposures in young children’.
Lavonas, EJ, Banner, W, Bradt, P, Bucher-Bartelson, B, Brown, KR, Rajan, P, Murrelle, L, Dart, RC & Green, JL 2013, ‘Root causes, clinical effects, and outcomes of unintentional exposures to buprenorphine by young children’, Journal of Pediatrics
, vol. 163, no. 5, pp. 1377-83.e3.
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How safe and effective are naltrexone implants?
Australian researchers reviewed the literature to assess the safety and efficacy of naltrexone implants for treating opioid dependence. They analysed studies which compared naltrexone implants with another intervention or placebo. They found that ‘Naltrexone implants were superior to placebo implants…and oral naltrexone…in suppressing opioid use. No difference in opioid use was observed between naltrexone implants and methadone maintenance…however, this finding was based on low-quality evidence from one study’. They commented that ‘The evidence on safety and efficacy of naltrexone implants is limited in quantity and quality, and the evidence has little clinical utility in settings where effective treatments for opioid dependence are used’. Their conclusion was that ‘Better designed research is needed to establish the safety and efficacy of naltrexone implants. Until such time, their use should be limited to clinical trials’.
Larney, S, Gowing, L, Mattick, RP, Farrell, M, Hall, W & Degenhardt, L 2013, ‘A systematic review and meta-analysis of naltrexone implants for the treatment of opioid dependence’, Drug and Alcohol Review
, online ahead of print.
Comment: Pharmaceutical product regulators continue to be pressured by some medical practitioners and members of the public to authorise the use of naltrexone implants as an opioid maintenance therapy. This authoritative new review confirms the fact that there is not yet sufficient evidence to permit such use. See ATODA’s policy statement on this topic at http://www.atoda.org.au/policy/naltrexone-opioid-treatment/.
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What are the guidelines on tobacco harm reduction?
The UK National Institute for Health and Clinical Excellence (NICE) publishes authoritative guidelines for people delivering health care or promoting well-being. It has recently updated its tobacco harm reduction guidelines
in light of the UK Government decision to regulate, as medicines, electronic cigarettes and all other nicotine containing products. An overview of the guidelines states that ‘Nicotine inhaled from smoking tobacco is highly addictive. But it is primarily the toxins and carcinogens in tobacco smoke –not the nicotine–that cause illness and death. The best way to reduce these illnesses and deaths is to stop smoking–ideally, stopping in one step (sometimes called ‘abrupt quitting’)…However, there are other ways of reducing the harm from smoking, even though this may involve continued use of nicotine. This guidance is about helping people, particularly those who are highly dependent on nicotine, who:
- may not be able (or do not want) to stop smoking in one step
- may want to stop smoking, without necessarily giving up nicotine
- may not be ready to stop smoking, but want to reduce the amount they smoke.
It recommends harm-reduction approaches which may or may not include temporary or long-term use of licensed nicotine-containing products. [This guidance] is especially aimed at those involved in providing advice about stopping smoking, including those working in smoking cessation services.
The recommendations cover awareness-raising, advising on, providing and selling licensed nicotine-containing products; self-help materials; behavioural support; and education and training for practitioners.
National Institute for Health and Clinical Excellence 2013, Tobacco: harm-reduction approaches to smoking
, NICE public health guidance 45, National Institute for Health and Clinical Excellence (UK), Manchester, UK, http://guidance.nice.org.uk/PH45
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How effective are e-cigarettes as an aid to smoking cessation?
A longitudinal internet survey assessed behaviour change over twelve months (2011 to 2013) in the users of e-cigarettes. The researchers found that ‘Most e-cigarette users were former smokers, who used e-cigarettes much like nicotine medications, to assist quitting, but with a longer duration of use. During the course of one year, use of e-cigarettes was remarkably stable in this group, even in those who had recently started to vape [use e-cigarettes]. Among vapers, very few ex-smokers relapsed to smoking, even among recent quitters. Dual users of e-cigarettes and conventional cigarettes reduced their cigarette consumption after they started to vape, and about half had stopped smoking at 1-year followup. While we are unable to establish causal links between vaping and smoking behavior from these observational data, our findings are consistent with the hypotheses that e-cigarettes provide an alternative to smoking; help former smokers avoid relapse; and help current smokers stop smoking…Importantly, our findings also suggest no deleterious effects of vaping on smoking behaviour, indeed they suggest e-cigarette use facilitates quitting, cutting down the number of cigarettes smoked and prevents relapse to smoking’.
Etter, J-F & Bullen, C 2014, ‘A longitudinal study of electronic cigarette users’, Addictive Behaviors
, vol. 39, no. 2, pp. 491-4.
Comment: An increasing number of studies are being published that demonstrate that the e-cigarettes are effective aids to smoking cessation and are more attractive, too many smokers, than are alternative approaches. Australian regulatory authorities have not yet attended sufficiently to this innovation. It should be noted that this is an Internet-based survey with self-selected participants.
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How effective are psychosocial interventions in reducing substance abuse by people with a severe mental illness?
A Cochrane review (also published in the journal Schizophrenia Bulletin
), which assessed the effectiveness of psychosocial interventions in reducing substance abuse by people with a severe mental illness, found that there was no consistent evidence to support any one psychosocial treatment over another.
This article is discussed at the website The Mental Elf
. The discussant, Marcus Munafò, comments ‘The results were extremely disappointing – there was no compelling evidence to support any one psychosocial treatment over another in this population, either to reduce substance use or improve mental health. The methodological limitations of the literature as a whole also limit the interpretation of these results, suggesting that even the benefits observed should be treated with caution. The authors conclude that there is a clear need for further high-quality trials which address these limitations, in order to improve the evidence base in this important area. This is an important conclusion – while a number of psychosocial interventions for substance use in people with mental health problems are available, they do not seem to work (or at least we have no clear evidence that they do). Better evidence is required regarding those interventions currently available, and most likely better interventions are required as well’.
Hunt, GE, Siegfried, N, Morley, K, Sitharthan, T & Cleary, M 2013, ‘Psychosocial interventions for people with both severe mental illness and substance misuse’, Schizophrenia Bulletin
, online ahead of print; Hunt, GE, Siegfried, N, Morley, K, Sitharthan, T & Cleary, M 2013, ‘Psychosocial interventions for people with both severe mental illness and substance misuse’, Cochrane Database Syst Rev
, vol. 10, p. CD001088,
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How valid and reliable is the Australian Treatment Outcomes Profile for measuring outcomes in opioid treatment program clinics?
Introduction and aims
: The measurement of clinical outcomes is an important, but lacking, component of drug and alcohol treatment in Australia. This study aimed to psychometrically validate the Treatment Outcomes Profile under Australian conditions, examining implementation and feasibility issues in three public opioid treatment program clinics in NSW.
Design and methods
: The Treatment Outcomes Profile was modified to reflect Australian conditions and re-named the Australian Treatment Outcomes Profile (ATOP). The ATOP was introduced into the participating clinics and administered by clinic staff at 3-month intervals as part of routine clinical practice. Participants completed a research interview, consisting of the ATOP and a suite of ‘gold standard’ instruments assessing substance use and related health and welfare domains, in the 72 h following completion of a routine clinical ATOP. The researcher- and clinician-administered ATOPs were compared to assess interrater reliability, and the researcher-administered ATOP and ‘gold standard’ instruments were compared to assess concurrent validity. Implementation and feasibility issues were assessed using questionnaires and focus groups with clinician and clients.
: The ATOP demonstrated acceptable concurrent validity [i.e. the instrument’s ability to distinguish between groups that it should theoretically be able to distinguish between] and interrater reliability. It was well received by clients and clinicians, particularly for its ease of use, applicability and brevity.
: The ATOP is a psychometrically valid instrument for the measurement of treatment outcomes in Australian opioid treatment populations and can feasibly be implemented as part of routine clinical practice in specialist opioid treatment program clinics. The role of the ATOP to measure outcomes in other drug and alcohol treatment modalities requires exploration.
Ryan, A, Holmes, J, Hunt, V, Dunlop, A, Mammen, K, Holland, R, Sutton, Y, Sindhusake, D, Rivas, G & Lintzeris, N 2013, ‘Validation and implementation of the Australian Treatment Outcomes Profile in specialist drug and alcohol settings’, Drug and Alcohol Review
, online ahead of print.
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ACT Government, Justice and Community Safety Directorate 2013, September 2013 quarter: Statistical profile, ACT criminal justice
, Justice and Community Safety Directorate, http://www.justice.act.gov.au/criminal_and_civil_justice/criminal_justice_statistical_profiles
Although reports in this series have been published for some years, their contents and formats have been substantially extended and improved commencing with the September 13 quarterly report.
Australian Bureau of Statistics 2013, Australian Aboriginal and Torres Strait Islander Health Survey: first results, Australia, 2012-13
Australian Library and Information Association 2013, Worth every cent and more: an independent assessment of the return on investment of health libraries in Australia
, ALIA, Deakin, ACT, http://www.alia.org.au/sites/default/files/Worth-Every-Cent-and-More-FULL-REPORT.pdf
Mathews, R & Legrand, T 2013, Risk-based licensing and alcohol-related offences in the Australian Capital Territory
, CEPS and FARE, Canberra, http://www.fare.org.au/wp-content/uploads/2011/07/Risk-based-licensing-and-alcohol-related-offences-in-the-ACT-Final.pdf
National Alliance for Action on Alcohol (NAAA) 2013, Benchmarking Australian governments’ progress towards preventing and reducing alcohol-related harm: National Alcohol Policy Scorecard, 2013 results
, NAAA, Melbourne, http://www.actiononalcohol.org.au/downloads/alcohol-policy-scorecard-2013.pdf
National Drug Strategy 2013, National Pharmaceutical Drug Misuse Framework for Action (2012-2015): a matter of balance
, National Drug Strategy, Canberra, http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/drug-mu-frm-action
National Health Performance Authority (Australia) 2013, Tobacco smoking rates across Australia, 2011–12 (In Focus)
, National Health Performance Authority, Canberra, http://www.myhealthycommunities.gov.au/publications
Nicholas, R, Adams, V, Roche, A, White, M & Battams, S 2013, A literature review to support the development of Australia’s alcohol and other drug workforce development strategy
, National Centre for Education and Training on Addiction, Flinders University, Adelaide, http://nceta.flinders.edu.au/general/news/national-alcohol-and-other-drug-workforce-development-strate/
Substance Abuse & Mental Health Services Administration, Department of Health and Human Services (USA) 2013, Opioid Overdose Prevention Toolkit,
For information on other reports
, please visit the ‘Did you see that report?
’ page at the website of the National Drugs Sector Information Service.
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