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.
ATODA congratulates the members of the ACT ATOD sector who presented at the recent APSAD conference on their excellent work. Abstracts for the presentations listed below are
Stakeholders are progressing a proposal to expand and strengthen alcohol, tobacco and other drug (ATOD) research in the ACT and region, and enhance ATOD policy and its implementation, through establishing a structured collaboration, such as a Centre for ATOD Research, Policy and Practice in the ACT. For more information please see the
. If you are interested in being involved please email Carrie Fowlie, Executive Officer, ATODA on
Attorney General, Simon Corbell, has recently announced that, as part of the dissemination of proceeds from the Confiscated Assets Trust Fund, $10,000 will be awarded to Alcohol Tobacco and Other Drug Association ACT (ATODA) to strengthen evidence based responses to alcohol and other drug related harms which can support the work of the collaboration.
Most of the items referenced below are available from the Alcohol and Other Drug Council of Australia’s
How effective are school-based prevention programs for alcohol and other drugs?
A review of the type and efficacy of Australian school-based prevention programs for alcohol and other drugs examined eight trials of seven intervention programs which targeted alcohol, cannabis and tobacco. The reviewers found that ‘Five of the seven intervention programs achieved reductions in alcohol, cannabis and tobacco use at follow up’. They concluded that ‘Existing school-based prevention programs have shown to be efficacious in the Australian context. However, there are only a few programs available, and these require further evaluative research. This is critical, given that substance use is such a significant public health problem. The findings challenge the commonly held view that school-based prevention programs are not effective’.
Teesson, M, Newton, NC & Barrett, EL 2012, ‘Australian school-based prevention programs for alcohol and other drugs: a systematic review’,
Drug and Alcohol Review, vol. 31, no. 6, pp. 731-6.
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How effective are school-based prevention programs for alcohol and other drugs that are delivered by the internet or computers?
Researchers based at the National Drug and Alcohol Research Centre reviewed twelve trials of ten school-based alcohol and other drug prevention programs targeting alcohol, cannabis and tobacco that were delivered via the internet or CD-ROM. They found that ‘Of the seven programs with available data, six achieved reductions in alcohol, cannabis or tobacco use at post intervention and/or follow up. Two interventions were associated with decreased intentions to use tobacco, and two significantly increased alcohol and drug-related knowledge’. They concluded that ‘existing computer- and internet-based prevention programs in schools have the potential to reduce alcohol and other drug use as well as intentions to use substances in the future. These findings, together with the implementation advantages and high fidelity associated with new technology, suggest that programs facilitated by computers and the internet offer a promising delivery method for school-based prevention’.
Champion, KE, Newton, NC, Barrett, EL & Teesson, M 2012, ‘A systematic review of school-based alcohol and other drug prevention programs facilitated by computers or the Internet’,
Drug and Alcohol Review, online ahead of print.
Comment: These two literature reviews are important as they demonstrate that school-based drug education can be successful. Although the effects sizes are relatively small, the fact that very large numbers of young people can be reached through school drug education means that the programs can have a worthwhile impact at the population level. This is known as the ‘prevention paradox’.
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How cost effective is a community-based public health approach to reducing cigarette smoking and delinquency?
The
Communities That Care (CTC) prevention program is based in the Center for Substance Abuse Prevention in the office of the US Substance Abuse and Mental Health Services Administration. It is also implemented in some parts of Australia. It is ‘a public health approach to reducing risk, enhancing protection, and reducing the prevalence of adolescent health and behavior problems community wide’. A cost-benefit analysis of the CTC was undertaken based on ‘outcomes from a panel of students followed from Grade 5 through Grade 8 in a randomized controlled trial involving 24 communities in 7 states’. An estimate was made of ‘long-term monetary benefits associated with significant intervention effects on cigarette smoking and delinquency as compared to the cost of conducting the intervention’. The researchers concluded that ‘Under conservative cost assumptions, the net present benefit is $5,250 per youth, including $812 from the prevention of cigarette smoking and $4,438 from the prevention of delinquency. The benefit-cost ratio indicates a return of $5.30 per $1.00 invested. Under less conservative but still viable cost assumptions, the benefit-cost ratio due to prevention of cigarette smoking and delinquency increases to $10.23 per $1.00 invested. Benefits from CTC’s reduction in alcohol initiation as well as broader inclusion of quality-of-life gains would further increase CTC’s benefit-cost ratio. Results provide evidence that CTC is a cost-beneficial preventive intervention and a good investment of public dollars, even under very conservative cost and benefit assumptions’.
Kuklinski, MR, Briney, JS, Hawkins, JD & Catalano, RF 2012, ‘Cost-benefit analysis of communities that care outcomes at eighth grade’,
Prevention Science, vol. 13, no. 2, pp. 150-61.
Comment: This type of evidence demonstrating that community-based prevention not only works but is also highly cost-effective leads one to wonder why prevention receives only a tiny proportion of the National Drug Strategy funding—and most of that goes to low-impact mass media initiatives.
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Does the imposition of minimum alcohol prices lead to a reduction in alcohol consumption?
A report published in the prestigious American Journal of Public Health analyses the impacts on alcohol consumption following new and increased minimum alcohol prices in Saskatchewan, Canada. The researchers examined alcohol sales and price data from the Saskatchewan government alcohol monopoly for 26 periods before and 26 periods after the intervention. They found ‘A 10% increase in minimum prices significantly reduced consumption of beer by 10.06%, spirits by 5.87%, wine by 4.58%, and all beverages combined by 8.43%. Consumption of coolers decreased significantly by 13.2%, cocktails by 21.3%, and liqueurs by 5.3%. There were larger effects for purely off-premise sales (e.g., liquor stores) than for primarily on-premise sales (e.g., bars, restaurants). Consumption of higher strength beer and wine declined the most. A 10% increase in minimum price was associated with a 22.0% decrease in consumption of higher strength beer (>6.5% alcohol/volume) versus 8.17% for lower strength beers. The neighboring province of Alberta showed no change in per capita alcohol consumption before and after the intervention’. The authors concluded ‘Minimum pricing is a promising strategy for reducing the public health burden associated with hazardous alcohol consumption. Pricing to reflect percentage alcohol content of drinks can shift consumption toward lower alcohol content beverage types’.
Stockwell, T, Zhao, J, Giesbrecht, N, Macdonald, S, Thomas, G & Wettlaufer, A 2012, ‘The raising of minimum alcohol prices in Saskatchewan, Canada: impacts on consumption and implications for public health’,
American Journal of Public Health, online ahead of print.
Comment: The evidence continues to build for a floor price for alcoholic beverages in Australia. Considering the reluctance of the Commonwealth Government to introduce a rational taxation regime for these harmful products, public health advocates are increasingly pushing for a minimum alcohol price approach instead.
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How effective are Australia’s needle and syringe programs in reducing HIV and HCV among people who inject drugs?
A researcher team based at the University of New South Wales evaluated the impact and cost-effectiveness of needle-syringe programs (NSPs) with respect to HIV and hepatitis C virus (HCV) infections among Australian people who inject illicit drugs (IDUs). They found that NSPs reduced the incidence (the number of new cases in a year) of HIV by 70% and HCV by 43% during 2000-2010, and ‘NSP coverage saved A$70-220 million in healthcare costs during 2000-2010 and will save an additional A$340-950 million in future healthcare costs. With NSPs costing A$245 million, the programs are very cost-effective at A$416-8,750 per QALY [quality-adjusted life year] gained. Financial investment in NSPs over 2000-2010 is estimated to be entirely recovered in healthcare cost savings by 2032 with a total future return on investment of $1.3-5.5 for every $1 invested’. They concluded ‘Australia’s early introduction and high coverage of NSPs has significantly reduced the prevalence of HIV and HCV among IDUs. NSPs are a cost-effective public health strategy and will result in substantial net cost savings in the future’.
Kwon, JA, Anderson, J, Kerr, CC, Thein, H-H, Zhang, L, Iversen, J, Dore, GJ, Kaldor, JM, Law, MG, Maher, L & Wilson, DP 2012, ‘Estimating the cost-effectiveness of needle-syringe programs in Australia’,
AIDS, online ahead of print.
Note: In the September 2012 issue of ATODA’s Research eBulletin we mentioned a poster presentation by the same authors with the same title. This refereed journal article is the more authoritative, published, version.
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Are smartphones encouraging teenagers to take up smoking?
A study of the availability of ‘pro-smoking’ apps in the Apple App store and Android Market indentified 107 pro-smoking apps, under categories including health and fitness, entertainment, games and lifestyle. The researchers state ‘Pro-smoking apps that show that smoking is “cool” in a cartoon game, and provide a chance to explore the available cigarette brands and even simulate the smoking experience with high quality, free apps could potentially increase teen’s [sic] risk of smoking initiation’. They comment ‘The availability of pro-smoking content in the app stores appears to be violating Article 13 of WHO Framework Convention on Tobacco Control…which bans advertising and promotion of tobacco products in all media including the internet’. They give examples of app store responses to country-specific laws and regulations that could be used to control the harmful contents in the app stores for individual countries.
BinDihm, NF, Freeman, B & Trevena, L 2012, ‘Pro-smoking apps for smartphones: the latest vehicle for the tobacco industry?’,
Tobacco Control, online ahead of print.
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Have we made the best use of the opportunities provided by the introduction of the National Drug Strategy, in relation to Aboriginal and Torres Strait Islander people?
In her 2011 James Rankin Oration, Canberra-based scholar Dr Maggie Brady addressed the topic ‘The National Drug Strategy and Indigenous Australians: missed opportunities and future challenges’. She recounted the failings and inadequacies of the early years of the Strategy and pointed to progress in more recent years in areas such as secondary prevention, better networking and Indigenous initiatives. She outlined challenges for the future: the increase in the Indigenous population which is estimated to rise by 2.2% compared to the average rate for the total Australian population of between 1.2% and 1.7%, the projected doubling of the number of Indigenous children by 2021, and the increasing integration of the Indigenous population though marriage. She concluded ‘We must ensure that Indigenous people are able to access the most competent, professional and culturally appropriate help possible—for dealing with alcohol and drug abuse cannot wait. Getting on top of these issues will ultimately contribute to the amelioration of disadvantaged social circumstances’.
Brady, M 2012, ‘The National Drug Strategy and Indigenous Australians: missed opportunities and future challenges’
Drug and Alcohol Review, vol. 31, no. 6, pp. 747-53.
Comment: The author’s observations and conclusions reinforce the importance of assisting Indigenous organisations to maintain and further build high-quality services for their communities, and for the mainstream services to operate in more culturally secure and welcoming way, as promoted through WANADA’s 2012
Standard On Culturally Secure Practice (Alcohol and Other Drug Sector).
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Are presentations to emergency departments by people with amphetamine-related problems, and their hospitalisations, an opportunity to counsel less risky behaviour?
Researchers based in Western Australian examined hospitalisations in a cohort of 138 patients who presented with an amphetamine-related problem to an emergency department (ED) in 2005. In the period five years before and four years after their presentation to an ED, 130 (94%) were admitted to hospital, most commonly for mental disorders, followed by injury and poisoning. The researchers suggest that ‘This provides multiple opportunities for brief interventions, such as giving advice or counselling on reducing or ceasing drug use…Referrals to relevant services can also be provided as necessary. If provided routinely at different sites before separation they could act as booster sessions for lifestyle change. Proactive brief interventions before separation have potential for substantial savings for public hospitals, and possibly preventing premature deaths’.
Fatovich, DM, Davis, G & Bartu, A 2012, ‘Morbidity associated with amphetamine-presentations to an emergency department: a record linkage study’,
Emergency Medicine Australasia, vol. 24, no. 5, pp. 553-9.
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What penalties are people convicted of drug driving likely to incur, and how likely are they to reoffend?
A NSW Bureau of Crime Statistics and Research Issue Paper investigates penalties for drug driving, risk of reconviction among drug drivers, and how penalties and reconviction risk vary according to offender characteristics. It is based on information for 3,770 offenders with proven drug-driving offences over the period 2007-2011. The research revealed that ‘The most common principal penalty for drug driving was a fine (60.2% received a fine and the average fine was $581). While 17.2 per cent of offenders had their matters dismissed without conviction, most dismissals (84%) also included a good behaviour bond. Offenders were less likely to have their matters dismissed if they were younger, had concurrent charges or a prior criminal record. One-third (35.3%) had been convicted for a new offence within 24 months. Recidivism was higher for offenders who had a prior criminal record, were not on bail and/or were Indigenous’. The conclusion of the research was that ‘The most common outcomes for drug driving are fines and dismissals. Those who have their matters dismissed tend to share characteristics with those at lower risk of recidivism’.
Taussig, I & Jones, C 2012,
Penalties and reconviction risk among offenders convicted of drug driving, Crime and Justice Statistics, Bureau Brief, Issue paper no. 79, Bureau of Crime Statistics and Research, Sydney.
Comment: Considering that ACT Policing is current currently building its capacity for more intense roadside drug testing in the ACT, it is hoped that the kind of information disseminated here from NSW will also be collected in the ACT as part of a comprehensive strategy to evaluate our roadside drug testing regime.
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What data are available about the effects of driving while under the influence of prescription drugs?
Researchers based in Maryland, USA, have drawn attention to the need for new research on the impairing effects of prescription drugs on driving. ‘While a physician’s prescription makes it legal for a person to use a controlled drug for medical purposes, it does not authorise individuals to drive while impaired. Thus, if drivers are impaired due to a prescribed controlled drug, they are subject to arrest and prosecution for DUI’. They state that ‘There is an increasing need to identify prescription drug-impaired drivers because the prevalence of non-medical prescription drug use [in USA] has reached epidemic levels, with 7 million past month non-medical users aged 12 and older. One can expect increased pressure on police and prosecutors to detect and convict such illicit prescription drug users’.
They point out that there are a number of constructive steps that can be taken to reduce prescription drug-based drug-driving, such as drug labelling and physician and pharmacist counselling, and go on to recommend areas for research and evaluation regarding drivers using prescription drugs.
Voas, RB, Dupont, RL, Shea, CL & Talpins, SK 2012, ‘Prescription drugs, drugged driving and per se laws’,
Injury Prevention, online ahead of print.
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What effect does hepatitis C have on quality of life?
A literature review was undertaken ‘to determine what is currently known about the health and psychosocial impacts of hepatitis C along the trajectory from exposure to ongoing chronic infection, and to identify what knowledge gaps remain’. The reviewers found that ‘Injecting drug use (IDU) was a major risk for transmission with seroconversion occurring relatively early in injecting careers. Persistent hepatitis C viraemia, increasing age and excessive alcohol consumption independently predicted disease progression. While interferon based therapies reduced quality of life during treatment, improvements on baseline quality of life was achieved post treatment—particularly when sustained viral response was achieved. Much of the negative social impact of chronic infection was due to the association of infection with IDU and inflated assessments of transmission risks. Perceived discrimination was commonly reported in health care settings, potentially impeding health care access. Perceptions of stigma and experiences of discrimination also had direct negative impacts on wellbeing and social functioning’.
The authors concluded that ‘Hepatitis C and its management continue to have profound and ongoing impacts on health and social well being. Biomedical studies provided prospective information on clinical aspects of infection, while the broader social and psychological studies presented comprehensive information on seminal experiences (such as diagnosis and disclosure). Increasing the focus on combined methodological approaches could enhance understanding about the health and social impacts of hepatitis C along the life course’.
Miller, ER, McNally, S, Wallace, J & Schlichthorst, M 2012, ‘The ongoing impacts of hepatitis c - a systematic narrative review of the literature’,
BMC Public Health, vol. 12, p. 672.
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How effective is police use of drug detection dogs in increasing detection of drugs or deterring people from drug possession and use?
Over two thousand regular ecstasy users were interviewed across Australia between 2008 and 2010 as part of the Ecstasy and Related Drugs Reporting System (EDRS). The researchers reported that ‘Over the 3 year period, there was increased visibility of drug detection dogs by regular ecstasy users. New South Wales was the jurisdiction with the most reported sightings, mainly occurring at festivals or live music events. Despite this police presence, however, detection and deterrence rates remained low. Approximately two-thirds of participants who had seen the drug detection dogs had drugs in their possession at the most recent sighting, yet less than 7% were positively identified by dogs. Further, the majority of participants in possession of drugs took no actions after sighting the dogs, whereas a small group hastily consumed the drugs’. They concluded that ‘The low proportion of reported positive notifications from the dogs by the participants who had drugs on them at the time of sighting questions the accuracy and effectiveness of this procedure. Despite the increased visibility of police drug detection dogs, regular ecstasy users continue to use and be in possession of illicit drugs in public, suggesting a limited deterrence effect. The hasty consumption of drugs upon sighting the dogs also raises health concerns’.
Hickey, S, McIlwraith, F, Bruno, R, Matthews, A & Alati, R 2012, ‘Drug detection dogs in Australia: more bark than bite?’, Drug and Alcohol Review, vol. 31, no. 6, pp. 778-83.
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New Reports
Australian Bureau of Statistics 2012, Australian Health Survey: first results, 2011-12, ABS.
Chapman, J 2012, Being real on drugs: a systems approach to drugs policy, Demos.
Jerram 2012, Findings of the NSW State Coroner: deaths of Mr James Unicomb, Mr Michael Poole & Ms Grace Yates, 27 September 2012, NSW State Coroner, Sydney.
Roxburgh, A & Burns, L 2012, Accidental opioid-induced deaths in Australia 2008, National Drug and Alcohol Research Centre, UNSW, Sydney.
Roxburgh, A & Burns, L 2012, Cocaine and methamphetamine induced deaths in Australia 2008, National Drug and Alcohol Research Centre, Sydney.
UK Drug Policy Commission 2012, A fresh approach to drugs: the final report of the UK Drug Policy Commission, UK Drug Policy Commission, London.
For information on other reports, please visit ‘Did you see that report?’ at the National Drugs Sector Information Service.
New book: Alcohol and drug misuse: a Cochrane handbook
The Research eBulletin series focuses on journal articles and reports, not books, as ADCA’s National Drugs Sector Information Service provides information on the most important newly-published books in our field, see ‘New Resources’.
This month, however, ATODA makes an exception, drawing your attention to a particularly important new book: Abraha, I & Cusi, C 2012, Alcohol and drug misuse: a Cochrane handbook, Wiley-Blackwell, Chichester, West Sussex. This is a ‘must have’ for people working in, or making policy about, the AOD treatment field, and keen to implement evidence-informed practice. Its role is to present, in a readily-accessible, summary form, the findings of highly technical systematic reviews of the scientific literature. It summarises 59 such reviews, mostly in two or three pages.
At its website, the publisher describes the book this way:
This Cochrane Handbook of Alcohol and Drug Misuse serves as a concise guide to the evidence base for relevant interventions, highlighting the key points of Cochrane reviews for the busy practitioner.
Each review is analysed in a structured format, starting with the question, a brief background and a summary answer, followed by the results presented in comprehensive and concise way. The authors then illustrate the value that the review adds to the current knowledge, the main methodological limitations of the included studies and finally the implications of the review’s conclusions for future research.
The book’s comprehensive coverage of interventions provides an authoritative reference for all physicians working with these patients, from family practitioners to clinical specialists and psychiatric specialists. With addiction to drugs and alcohol an increasingly serious morbidity and public health issue, this book from the Cochrane Collaboration will find a wide audience.
Please see the book’s table of contents. It costs about $42, including p&p, from the Book Depository, or $53 from the Co-op Bookshop.
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Australian Treatment Outcomes Study – searching for previous participants
Did you have clients who participated in the Australian Treatment Outcomes Study between 2001 and 2002? The study by the National Drug and Alcohol Research Centre recruited 615 people in NSW who were in treatment for heroin dependence. They were followed up three years later.
Now, funding has been received from the National Health and Medical Research Council to conduct a further 11-year follow-up of these individuals, tracking the long-term trajectory of heroin dependence.
If you or your clients were involved in the original ATOS study, please see this
article contact Jo White at NDARC on (02) 9385 0304 or 0477 426 503 or email
joanne.white@unsw.edu.au
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