Our 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.
Tobacco interventions have successfully supported the ACT’s smoking rate drop to the lowest in Australia. However, there are subsections of the population where smoking rates remain unacceptably high (30 – 90%) and where conventional interventions have failed. In 2010, ACT Health funded ATODA to pilot a project to assist ATOD, mental health and youth non-government organisations to implement ACT Health’s Smoke-Free Workplace Policy.
A staged project approach, with research and project management capacity, to work with each pilot site to identify needs, determine intervention approaches, develop and implement site workplans and record decision pathways for policy and intervention approaches.
Initial surveys identified that 52% of staff working in the pilot sites smoked, 79% reported previous quit attempts and a similar number of staff wanted to reduce or quit. A number of staff misconceptions existed and very few staff had undertaken any tobacco control training. Two of nine workplaces had a tobacco policy. Most organisations had both a formal and informal culture of smoking. Three month follow-up indicates a reduction in smoking rates and in smoking behaviour amongst staff. At the organisational new workplace tobacco management policies are in place and others are in the process of developing and implementing.
Tobacco management in workplaces with high smoking rates requires dedicated approaches.
This project approach may have broad relevance for the non-government sector wanting to reduce smoking behaviours.
In September a discussion paper was developed and distributed to identified researchers based within the ACT. On 11 October 2011 a workshop was held with cross-institutional researchers, practitioners and policy makers in the ACT. At the workshop it was agreed to progress establishing a collaboration, such as a Centre for Drug Research, Policy and Practice in the ACT. Participants included representatives from the Australian National University, University of Canberra, Australian Catholic University, ACT Government Health Directorate, ATODA and the ATOD sector. For more information please see the attached briefing.
If you are interested in being involved please email Carrie Fowlie, Executive Officer, ATODA on
American scholar Mark Kleiman is one of the most progressive thinkers and researchers working on making our criminal justice systems (especially as they deal with offenders with alcohol- and other drug-related offending) more effective and, importantly, more cost-effective. He and colleagues have built the evidence base for focussing resources on preventing recidivism as the key to success, and have recently tied this to the concept of justice reinvestment, i.e. providing funds for community-based services that prevent people offending and being incarcerated, thus reducing prison costs. Kleiman points out that ‘Less incarceration, lower spending, and less crime should be an attractive package, and many relevant political actors might find it so if they were offered an explicit choice…In the short run…the marginal cost of a prison is much less than the average cost;…a small reduction in prison headcount might not lead to substantial budget savings. The big savings appear only when the reduction leads to closing an institution, or to not building a new one.’
He points out that ‘The literature on recidivism reduction via service delivery—the “reentry” literature—for the most part, makes for fairly depressing reading; a program that moves the 3-year return-to-prison rate from 66% to 60% counts as a success. Given that the total annual prison budget [of the USA] is only $60 billion, the potential savings from reduced incarceration can hardly finance major increases in social-service budgets or fuel major upsurges in neighborhood economic activity, even if spent in ways that lead to respending within the affected neighborhoods. By contrast, there are strong reasons to think that improved probation and parole supervision—as opposed to enhanced services—can make a big difference in reoffending and reincarceration, and can do so for small sums compared with the savings from reduced reincarceration.’
Kleiman, MAR 2011, ‘Justice reinvestment in community supervision’,
Criminology & Public Policy, vol. 10, no. 3, pp. 651-9. See also Kleiman, MAR 2009,
When brute force fails: how to have less crime and less punishment, Princeton University Press, Princeton.
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Do financial sanctions add to the difficulties faced by ex-prisoners?
A study reported in the
Australian and New Zealand Journal of Criminologyinvestigated the debt burdens of 156 NSW prisoners, 95% of whom reported debt to the NSW State Debt Recovery Office (SDRO). ‘Participants who provided an estimate of their debt reported an average of $12,161 owed to the SDRO, compared to their verifiable average of $8,854. Eighteen per cent of participants with SDRO debt had incurred their earliest outstanding fine when they were younger than 18 years old. Sixty-four per cent perceived their SDRO debt as stressful; and 94 per cent reported that their debt was made worse by drugs (92%) and/or fine enforcement actions (50%). Based on the average Australian pension income and repayments of $15 per week, the average SDRO debt would take an ex-inmate 11 years to repay. Given the many challenges faced by these individuals upon re-entry to the community the additional strain imposed by unmanageable financial penalties should not be ignored. Steps are required to ensure that the criminal justice need for retribution is balanced against the benefit of having ex-prisoners re/join and contribute to a safe and law-abiding society.’
Martire, K, Sunjic, S, Topp, L & Indig, D 2011, ‘Financial sanctions and the justice system: fine debts among New South Wales prisoners with a history of problematic substance use’,
Australian and New Zealand Journal of Criminology, vol. 44, no. 2, pp. 258-71.
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Do police crackdowns on crime simply result in a relocation of the criminal activity?
A criticism of geographically-focused policing activities is that ‘crime will simply relocate to other times and places since the root causes of crime were not addressed’. However, an authoritative systematic review from the Campbell Collaboration of spatially-focused policing efforts has found that ‘…displacement is far from inevitable as a result of such endeavor, and, in fact that the opposite, a diffusion of crime control benefits appears to be the more likely consequence’. The diffusion effect refers to reductions in the amount of crime occurring in localities that are geographically close to where the crime prevention interventions take place, even though those areas were not actually targeted by the crime prevention intervention itself.
Bowers, K, Johnson, S, Guerette, RT, Summers, L & Poynton, S 2011, ‘Spatial displacement and diffusion of benefits among geographically focused policing initiatives’,
Campbell Systematic Reviews, vol. 2011.3, p. 147,
http://campbellcollaboration.org/lib/download/1171/.
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How can people who use illicit opioids be encouraged into opioid substitution therapy?
A systematic review of studies designed to encourage people who inject illicit opioids into opioid substitution treatment (OST) classified the therapies into motivational interventions (MI) (such as cognitive behavioural therapy, the Miller model and the stages of change approach), case management (CM) and mixed approaches. ‘Individuals exposed to MI were 1.46 times more likely to enter treatment at follow-up…and individuals exposed to CM were 2.95 times more likely to be entering treatment at follow-up…’ than the controls. The researchers concluded that ‘The results of this review suggest there is a promising affect for CM and MI approaches in engaging out of treatment IDUs to enter OST. However, further studies are required in order to strengthen the evidence base and demonstrate that these interventions can be effective outside the USA.’
Roberts, J, Annett, H & Hickman, M 2011, ‘A systematic review of interventions to increase the uptake of opiate substitution therapy in injecting drug users’,
Journal of Public Health (Oxf), vol. 33, no. 3, pp. 378-84,
http://jpubhealth.oxfordjournals.org/content/early/2010/11/02/pubmed.fdq088.abstract.
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How effective is motivational interviewing in helping people to reduce their use of alcohol and other drugs?
In an important new systematic review, researchers analysed studies that had included people with alcohol or other drug problems and that had divided them by chance into motivational interviewing (MI) or a control group that received either no treatment or some other treatment. They found that people who received MI which aimed at helping them reduce or stop their use of illicit drugs and/or alcohol ‘…reduced their use of substances more than people who have not received any treatment. However, it seems that other active treatments, treatment as usual and being assessed and receiving feedback can be as effective as motivational interviewing. There was not enough data to conclude about the effects of MI on retention in treatment, readiness to change, or repeat convictions. The quality of the research forces us to be careful about our conclusions, and new research may change them.’
Smedslund, G, Berg, RC, Hammerstrøm, KT, Steiro, A, Leiknes, KA, Dahl, HM & Karlsen, K 2011, ‘Motivational interviewing for substance abuse’,
Campbell Systematic Reviews, vol. 2011:6,
http://www.campbellcollaboration.org/lib/download/1421/.
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Will rewarding treatment services that achieve better client outcomes have an adverse effect on clients with more complex problems?
An article in a recent issue of
Addiction explains that ‘The UK government is changing its system of payment for drug treatment services in order to reward the achievement of better patient outcomes…This “payment by results” funding system will reward providers for achieving good outcomes in terms of whether clients are drug free, employed and/or not convicted of a criminal offence. Providers will also receive a payment based on health and wellbeing outcome measurement.’ The authors warn, however, that ‘It is essential that careful evaluation and monitoring ensures that this new remuneration system does not unintentionally have a negative impact on the most complex clients, either through perverse incentives for providers to discharge clients from treatment too soon or to prioritize treatment of less complex clients who are more likely to achieve those outcomes for [which] payments are made. Changing payment schemes tends to create opportunities for risk shifting and cream-skimming that undermines funder and client wellbeing. Such reform should proceed with careful planning and evaluation of policy options.’
Maynard, A, Street, A & Hunter, R 2011, ‘Using “payment by results” to fund the treatment of dependent drug users—proceed with care!’,
Addiction, vol. 106, no. 10, pp. 1725-9.
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What information is available on patterns of opioid use and on responses designed to reduce harms associated with opioid use?
The September 2011 issue of ADF’s
Prevention Research Quarterly describes some of the patterns of opioid use along with the key harms experienced by people who use illicit opioids, and considers ‘some of the prevention and treatment responses designed to reduce the harms associated with the use of heroin and other opioids’. The September 2011
DrugInfo Newsletter also focuses on the treatment models available for opioid misuse, and gives practical examples of some of these.
Dietze, P, Degenhardt, L, Kinner, S & Hellard, M 2011, ‘Heroin and other opioids’,
Prevention Research Quarterly, no. 16,
http://www.druginfo.adf.org.au/attachments/446_PRQ_heroin_Sep11.pdf.
‘Heroin and other opioids’
, DrugInfo newsletter, volume 9, number 3, September 2011,
http://www.druginfo.adf.org.au/newsletters/newsletters-heroin-and-other-opioids.
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Does the UK Government really state that naloxone drug kits save lives?
Yes it does! An August 2011 media release from the UK National Treatment Agency reads as follows:
The deaths of at least 20 addicts were prevented during the course of a ground-breaking new trial in which their friends and family were given the heroin “antidote” naloxone and training in life-saving techniques to cope with overdose situations.
At 16 pilot sites around England, 495 carers were trained to respond to an overdose using basic life support techniques. Those at 15 sites were also trained to administer naloxone which reverses the effects of heroin and other opioids for long enough for medical help to arrive.
In a report issued today, the National Treatment Agency for Substance Misuse (NTA) said that during the trial (July 2009 to February 2010) and to date there have been 18 overdoses where carers used naloxone and two where they applied basic life support. All the drug users survived the overdose.
NTA chief executive Paul Hayes said: “Overdoses often occur when friends or family are near at hand and if they can be trained in how to manage such an emergency and keep the victim alive while waiting for the ambulance, potentially hundreds of lives could be saved in the UK every year.
“This project feeds into a key area of our work on preventing drug related deaths. We are also currently supporting local areas to improve the way they review and record such deaths to provide a more robust evidence base to help shape local policies on this important harm reduction and recovery issue.”
National Treatment Agency for Substance Misuse 2011,
The NTA overdose and naloxone training programme for families and carers, National Treatment Agency for Substance Misuse, London, media release:
http://www.nta.nhs.uk/news-2011-naloxone-report.aspxand report:
http://www.nta.nhs.uk/uploads/naloxonereport2011.pdf.
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Are young adults who use cannabis more likely to progress to using other drugs than non-cannabis users?
A longitudinal study that followed Victorian secondary school students into early adulthood has found that ‘…frequent cannabis use in young adulthood was associated with increased rates of
progression in both cigarette smoking and other illicit drug use. Never having used cannabis predicted substantially reduced rates of uptake of all other drugs. So too, quitting cannabis predicted a reduced uptake of drug use, particularly of illicit drugs’. The researchers conclude that ‘Preventing cannabis use uptake and use escalation remain crucial health aims given the burden associated with cigarette, alcohol and illicit drug use’.
Swift, W, Coffey, C, Degenhardt, L, Carlin, JB, Romaniuk, H & Patton, GC 2011, ‘Cannabis and progression to other substance use in young adults: findings from a 13-year prospective population-based study’,
Journal of Epidemiology and Community Health, doi:10.1136/jech.2010.129056.
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Does exposure to secondhand smoke in the home have a detrimental effect on young children?
A nation-wide study in the United States examined the association between children being exposed to secondhand smoke (SHS) at home and their suffering from neurobehavioral disorders such as attention-deficit/hyperactivity disorder, learning disabilities, and conduct disorders. The research revealed that ‘A total of 4.8 million US children younger than 12 are exposed to SHS in their homes, and 3% to 8% suffered from 1 or more neurobehavioral disorders…274,100 excess cases of these disorders could have been prevented had children not been exposed to SHS in their homes’.
Kabir, Z, Connolly, GN & Alpert, HR 2011, ‘Secondhand smoke exposure and neurobehavioral disorders among children in the United States’,
Pediatrics, vol. 128, no. 2, pp. 263-70.
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Why is abstinence the primary treatment goal of alcohol counsellors, rather than low-risk drinking?
An editorial in the October 2011 issue of the leading international journal
Addiction by prominent alcohol treatment researchers Mark Sobell and Linda Sobell is titled ‘It is time for low-risk drinking goals to come out of the closet’. The authors state that ‘Despite decades of mounting scientific evidence that low-risk drinking outcomes occur and are common, low-risk drinking is still a closet treatment goal, at least in the United States…(because) clinicians largely ignore the evidence’. The authors suggest that ‘…the failure by alcohol counselors in the United States to offer low-risk drinking goals is due to their being trained through an apprenticeship model rather than an evidence-based academic model, as used to train other health professionals’. They conclude with a challenge to counsellors and others: ‘What will it take for the field and clinicians who purport to help individuals with alcohol problems to offer evidence-based treatments for problem drinkers, the “underserved majority”? Until this happens, providers and the field will continue to force problem drinkers to keep their pursuit of low-risk drinking a private struggle.’
Sobell, MB & Sobell, LC 2011, ‘It is time for low-risk drinking goals to come out of the closet’,
Addiction, vol. 106, no. 10, pp. 1715-7.
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Where does the Alcohol Policy Coalition stand on tackling alcohol problems within the context of non-communicable disease prevention and control?
The Alcohol Policy Coalition is a collaboration of Australian health agencies—the Australian Drug Foundation, Cancer Council Victoria, Heart Foundation, Turning Point Alcohol and Drug Centre and VicHealth—with shared concern relating to the misuse of alcohol and its health and social impacts on the community. In tandem with the landmark September 2011 High-level Meeting of the UN General Assembly on the Prevention and Control of Non-communicable Diseases, the Coalition released a position paper on cancer, cardiovascular disease and alcohol consumption. Their media release was headed ‘Myth busted: red wine no magic remedy for heart disease’, although this topic composes only a small part of the position paper. The Position Paper reinforces the Coalition’s policy proposals in the areas of alcohol affordability (volumetric taxation), alcohol availability (reducing it) and alcohol promotion (better controls).
Alcohol Policy Coalition 2011,
Alcohol Policy Coalition Position Statement: cancer, cardiovascular disease and alcohol consumption, Alcohol Policy Coalition, n.p.,
http://tinyurl.com/449e9kb. Media release at
http://tinyurl.com/3ze65xp .
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