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, produced by the Epidemiology Section, Population Health Division of the ACT Government Health Directorate provides information on the health of Aboriginal and Torres Strait Islander people in the ACT. Some data specific to alcohol, tobacco and other drugs is compiled in this report including:
In 2008, the National Aboriginal and Torres Strait Islander Social Survey found that:
ACT Government Health Directorate. (2013).
. Health Series Number 58. Australian Capital Territory: Canberra.
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
Most of the reports and research items referenced below are available from the Alcohol and Other Drug Council of Australia’s
Is it cost-effective to provide naloxone to heroin users to reduce overdose deaths?
A study in the USA of the published literature analysed the cost-effectiveness of distributing naloxone (Narcan®) to heroin users for use by witnesses at overdoses. The results were ‘6% of overdose deaths were prevented with naloxone distribution; 1 death was prevented for every 227 naloxone kits distributed…Naloxone distribution increased costs by [US]$53…and quality-adjusted life-years by 0.119…for an ICER [incremental cost-effectiveness ratio] of $438’. The conclusion of the report of the study is that ‘Naloxone distribution to heroin users is likely to reduce overdose deaths and is cost-effective, even under markedly conservative assumptions’.
Coffin, PO & Sullivan, SD 2013, ‘Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal’,
Annals of Internal Medicine, vol. 158, no. 1, pp. 1-9.
Comment: The Canberra I-ENAACT study of providing training in responding to opioid overdoses, and providing naloxone to potential overdose witnesses, is proceeding well. The US cost-effectiveness study provides further support for this type of intervention.
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Does illict drug use in Australia change over the Christmas-New Year period?
A team of researchers analysed samples collected daily over the period 23 December 2010 to 3 January 2011 from three wastewater treatment plants in south east Queensland—a coastal urban area, an inland semi-rural area and a holiday island—to ascertain changes in illicit drug use. They found that ‘Cannabis and methamphetamine were used in all areas and were less affected by weekend effects. Cocaine and MDMA, by contrast, were more abundant in the urban and vacation areas, and their use increased substantially in all regions during the peak holiday period’. They concluded that ‘While the peak holiday season in Australia is perceived as a period of increased drug use, this is not uniform across all drugs and areas. Substantial declines in drug use in the semi-rural area contrasted with substantial increases in urban and vacation areas. Per capita drug consumption in the vacation area was equivalent to that in the urban area, implying that these locations merit particular attention for drug use monitoring and harm minimisation measures’.
Lai, FY, Bruno, R, Hall, W, Gartner, C, Ort, C, Kirkbride, P, Prichard, J, Thai, PK, Carter, S & Mueller, JF 2012, ‘Profiles of illicit drug use during annual key holiday and control periods in Australia: wastewater analysis in an urban, a semi-rural and a vacation area’,
Addiction, online ahead of print.
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Is it true that the younger you are when you have your first taste of alcohol the more likely you are to have problems associated with drinking?
An international study investigated the association between the age at first drink (AFDrink) and the level of smoking, cannabis use, injuries, fights, and low academic performance at the age of 15. The AFDrink was taken into account in a sample of nearly 45,000 15-year-olds in 38 different North American and European countries and regions. Among those with drunkenness experience, the researchers tested ‘whether AFDrink predicted problem behaviors over and above the age at first drunkenness (AFDrunk)’. The researchers found that ‘Not early alcohol initiation but early drunkenness was a risk factor for various adolescent problem behaviors at the age of 15…’. They concluded ‘Besides targeting early drinking, particular efforts are needed to impede early drunkenness to prevent associated harm in adolescence and beyond’.
Kuntsche, E, Rossow, I, Simons-Morton, B, Bogt, TT, Kokkevi, A & Godeau, E 2012, ‘Not early drinking but early drunkenness is a risk factor for problem behaviors among adolescents from 38 European and North American countries’,
Alcoholism, Clinical and Experimental Research, vol. 37, no 2, pp. 308-314.
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How effective are vehicle alcohol interlocks as a means of improving driving safety?
‘Efforts are underway to encourage alcohol interlocks for all impaired driving offenders [driving under the influence (DUI)] in the USA. Interlocks require breath-alcohol concentration (BrAC) tests and prevent engine startups when BrAC is above preset levels. Interlock programs have grown rapidly; however, the devices are only effective while installed. Clearly, we need to strengthen effectiveness while installed, but also to improve monitoring and extend the installed duration when there is evidence of persistent excessive drinking. Perhaps most importantly, we need to improve the safety benefits achieved while installed for long after interlocks have been removed.
‘New alcohol technologies provide monitoring alternatives. Two are transdermal alcohol detection and photo identification systems for interlocks. Transdermal units lock onto the ankle and yield nearly continuous readings of alcohol vapor at the skin. Positive photo identification of interlock test-takers makes it difficult for offenders to blame lockouts on other vehicle users.
‘In sum, more interlocks are going on more offender cars, and there is growing recognition of the need to install soon after detection and arrest, rather than after long periods of license suspension. But, little effort is underway to actively monitor and mount supplemental interventions on higher risk interlock DUI offenders. Progress on the latter, and most difficult, element will be needed to break the cycle of catch and release.
Marques, P & Voas, R 2012, ‘Are we near a limit or can we get more safety from vehicle alcohol interlocks?’,
Addiction, online ahead of print.
Comment: Plans are being developed for alcohol ignition interlocks in the ACT. This commentary by leading international authorities highlights the need to use interlocks strategically as part of a comprehensive program to reduce drink-driving.
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Does alcohol use following drug treatment impact upon treatment effectiveness?
A research team based at Deakin University, Victoria, conducted a systematic review of the literature to investigate whether concurrent alcohol use could impede recovery from illicit drug use: whether alcohol could become a substitute addiction, and/or whether alcohol misuse post-treatment could be a risk for relapse to the original illicit drug problem. They found ‘inconsistent and therefore inconclusive support for the substitution hypothesis. However, the data revealed consistent support for the hypothesis that alcohol use increases relapse to drug use’. They argue that ‘future drug treatment outcome studies need to include detailed analysis of the influence of alcohol use pre- and post-drug treatment’.
Staiger, PK
et al. 2012, ‘Overlooked and underestimated? Problematic alcohol use in clients recovering from drug dependence’,
Addiction, online ahead of print.
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Is methamphetamine use likely to lead to an increase in psychotic symptoms?
A study of 278 methamphetamine users in Sydney and Brisbane conducted by Canberra and interstate researchers found that ‘There was a 5-fold increase in the likelihood of psychotic symptoms [suspiciousness, hallucinations, or unusual thought content] during periods of methamphetamine use relative to periods of no use]… this increase being strongly dose-dependent…Frequent cannabis and/or alcohol…further increased the odds of psychotic symptoms’.
McKetin, R, Lubman, DI, Baker, AL, Dawe, S & Ali, RL 2013, ‘Dose-related psychotic symptoms in chronic methamphetamine users: evidence from a prospective longitudinal study’,
JAMA Psychiatry, online ahead of print.
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Are people who start to use cannabis as teenagers more likely to develop psychosis than people who start using as adults?
This study by Western Australian researchers investigated ‘the existence of a temporal association between age at initiation of cannabis use and age at onset of psychotic illness in 997 participants from the 2010 Survey of High Impact Psychosis (SHIP) in Australia’. They investigated differences in age at onset of psychotic illness and length of time people used cannabis before showing psychotic symptoms.
The research revealed that the ‘association between age at initiation of cannabis use and age at onset of psychotic illness was linear and significant,…even after adjusting for confounders. The effect of age at initiation of cannabis use on [duration of premorbid exposure to cannabis] was not significant (mean duration of 7.8 years)….A temporal direct relationship between age at initiation of cannabis use and age at onset of psychotic illness was detected with a premorbid exposure to cannabis trend of 7-8 years, modifiable by higher severity of premorbid cannabis use and a diagnosis of [schizophrenia-spectrum disorder]. Cannabis may exert a cumulative toxic effect on individuals on the pathway to developing psychosis, the manifestation of which is delayed for approximately 7-8 years, regardless of age at which cannabis use was initiated.
Comment: This study suggests that it may not be that cannabis use in teenage years per se is more likely to precipitate symptoms of psychosis than using the drug in adult years. It suggests, rather, that the length of time people use is more important than the age at which use commenced. Such a finding is not inconsistent with contemporary initiatives to delay the uptake of cannabis use among young people.
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What type of school-based brief interventions for teenagers identified as problematic alcohol and other drugs users are most effective?
A randomised control trial in the USA evaluated the effectiveness of two types of brief interventions in a school setting for adolescents using alcohol and other drugs in a problematic manner. The students and their parents were assigned to receive either a two-session adolescent-only brief intervention (BI-A), a two-session adolescent and additional parent brief intervention session (BI-AP), or an assessment-only control condition (CON). ‘Adolescents and parents were assessed at intake and at 6 months following the completion of the intervention. Analyses of relative (change from intake to 6 months) and absolute (status at 6 months) outcome variables indicated that for the most part, adolescents in the BI-A and BI-AP conditions showed significantly more reductions in drug use behaviors compared with the CON group. In addition, youth receiving the BI-AP condition showed significantly better outcomes compared with the BI-A group on several variables. Problem-solving skills and use of additional counseling services mediated outcome’.
Winters, KC, Fahnhorst, T, Botzet, A, Lee, S & Lalone, B 2012, ‘Brief intervention for drug-abusing adolescents in a school setting: outcomes and mediating factors’,
Journal of Substance Abuse Treatment, vol. 42, no. 3, pp. 279-88.
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What are the trends in Indigenous smoking rates?
Analysis of responses to smoking questions in national Indigenous surveys from 1994 to 2008 shows that ‘Male Indigenous smoking prevalence fell significantly from 58.5% in 1994 to 52.6% in 2008…with the same decline in remote and non-remote areas. Female smoking fell from 51.0% to 47.4%, with markedly different changes in remote and non-remote areas. In non-remote areas, there was an absolute decrease in female smoking…but in remote areas, female smoking increased...From 2002 to 2008, the percentage of ever-smokers who had quit (quit ratio) increased absolutely by 1% per year in both men and women, remote and non-remote areas.’
In 2011 the then Federal Minister for Health, the Hon Nicola Roxon, committed to halving the Indigenous smoking prevalence by 2018 and dramatically increased Indigenous-specific funding and activity in tobacco control. The researcher points out that ‘reported historical trends in this paper are encouraging as they occurred at a time when there was little such tobacco control activity focused on Aboriginal and Torres Strait Islander people. However, to meet the [then] Minister’s goal, Indigenous smoking prevalence will need to fall more than six times as quickly as occurred from 1994 to 2008’.
Thomas, D 2012, ‘National trends in Aboriginal and Torres Strait Islander smoking and quitting, 1994-2008',
Australian and New Zealand Journal of Public Health, vol. 36, no. 1, pp. 24-9.
Comment: This evidence for falling smoking prevalence rates in much of the Indigenous population is good news but, as the author points out, huge challenges remain to move these rates down to levels comparable to, or below, those of the non-Indigenous community.
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Can interventions delivered by mobile phones help people to stop smoking?
A systematic review conducted by Australian and overseas members of the Cochrane Tobacco Addiction Group examined research on the potential of using mobile phones to deliver health advice on topics such as smoking cessation. Five studies were included: three involved text messages only; one comprised a text messaging intervention and an internet QuitCoach separately and in combination; and the fifth involved a video messaging intervention delivered via the mobile phone. The reviewers state that ‘Combined, evidence from five studies included in this review finds that interventions delivered by mobile phones can help people stop smoking, though the results from individual studies varied. The interventions included in this review mainly use text messaging to provide motivation, support and tips for quitting. There are no published studies on smartphone applications designed to help people stop smoking.’
Whittaker, R, McRobbie, H, Bullen, C, Borland, R, Rodgers, A & Gu, Y 2012, ‘Mobile phone-based interventions for smoking cessation ‘,
Cochrane Database of Systematic Reviews, no. 11, p. Art. No.: CD006611, .
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How effective are stop-smoking medications in helping smokers to quit?
Between 2006 and 2009, 2550 smokers in the United Kingdom, Canada, Australia and the United States were telephoned at random and interviewed as part of the International Tobacco Control Four Country Survey about their attempts to quit smoking. Results from the study indicate that ‘smoking cessation rates are higher among those using varenicline, bupropion or the nicotine patch compared to those attempting to quit without medication; however, no clear effects for oral NRT use were found. Despite the cessation advantage gained by using varenicline, bupropion or the nicotine patch, however, many of those making quit attempts do so without the aid of any medication. Thus, in theory, population quit rates could be increased by promoting use of demonstrably effective stop-smoking medications. However, even among those using these medications to help them stop smoking, relapse to smoking remains the norm, thus reinforcing the need for efforts to develop and deliver more effective treatments to help smokers to quit’.
Kasza, KA, Hyland, AJ, Borland, R, McNeill, AD, Bansal-Travers, M, Fix, BV, Hammond, D, Fong, GT & Cummings, KM 2013, ‘Effectiveness of stop-smoking medications: findings from the International Tobacco Control (ITC) Four Country Survey’,
Addiction, vol. 108, no. 1, pp. 193-202.
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How much of the Australian public supports banning the sale of tobacco?
In a Research Letter published in the leading journal Tobacco Control, researchers from the Centre for Behavioural Research in Cancer at the Cancer Council Victoria report on a Victorian survey of public opinion on banning tobacco sales. In their 2010 survey they found that 71% of Victorian adults and 58% of smokers responded that, ‘…at some time in the future, the sale of cigarettes from retail outlets should be made illegal. Overall, 53% of adults and 42% of smokers believed a ban should occur within the next 10 years, while a quarter of adults and 38% of smokers stated that cigarette sales should never be banned.’
Haye, L, Wakefield, MA & Scollo, MM 2013, ‘Public opinion about ending the sale of tobacco in Australia’,
Tobacco Control, online ahead of print.
Comment: Prohibiting the sale of tobacco products to the whole population, or to people born in the year 2000 or subsequently, is increasingly being discussed in tobacco control circles and more broadly. At the same time we are seeing moves in Australia to reduce the impact of prohibition with respect to some of the currently-illegal drugs, especially cannabis, and some overseas jurisdictions are legalising this drug. With a solid majority of the Australian community—smokers and non-smokers alike—stating that they support tobacco prohibition, this option warrants serious consideration by policy-makers. The challenge would be to design a prohibition regime that achieves sound public health outcomes while avoiding the damaging consequences of the current cannabis prohibition model.
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New Reports
Drug Policy Modelling Program 2013, Supervised injecting facilities – annotated bibliography, DPMP, Sydney.
Ritter, A, Bright, D & Gong, W 2012, Evaluating drug law enforcement interventions directed towards methamphetamine in Australia, Monograph Series no. 44, National Drug Law Enforcement Research Fund, Canberra.
Vel-Palumbo, Md, Matthew-Simmons, F, Shanahan, M & Ritter, A 2013, Supervised injecting facilities: what the literature tells us?, DPMP Bulletin Series no. 22, National Drug & Alcohol Research Centre, Sydney.
Deloitte Access Economics 2013, An economic analysis for Aboriginal and Torres Strait Islander offenders: prison vs residential treatment, Australian National Council on Drugs, Canberra.
National Indigenous Drug and Alcohol Committee, Australian National Council on Drugs 2013, Bridges and barriers: addressing Indigenous incarceration and health, revised edition, Australian National Council on Drugs, Canberra.
Kensy, J, Stengel, C, Nougier, M & Birgin, R 2012, Drug policy and women: addressing the negative consequences of harmful drug control, International Drug Policy Consortium, London.
Miller, P, Diment, C & Zinkiewicz, L 2012, ‘The role of alcohol in crime and disorder’, Prevention Research Quarterly, no. 18.
White, V & Bariola, E 2012, Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2011: report, Centre for Behavioural Research in Cancer, Cancer Control Research Institute, The Cancer Council Victoria, Melbourne.
Presentation by Professor Carla Treloar, National Centre in HIV Social Research, at the 2012 NSW NSP Workers Forum: Finding the needle in the haystack: an overview of new social research.
National Drug Research Institute 2013, Centrelines, NDRI (37), National Drug Resarch Institute, Perth
National Drugs Sector Information Service 2013, ADCA Recommends..., 4th edition, Alcohol and other Drugs Council of Australia, Canberra
The Economist Intelligence Unit Limited 2012, The Silent Pandemic: tackling hepatitis C with policy innocation, The Economist.
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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